Chapter 40 - Current Status of Islet Transplantation

Abstract

Islet transplantation has been proposed as a therapeutic option for patients with type 1 diabetes mellitus who have poor glycemic control with insulin therapy. The procedure is generally effective in reducing the frequency and severity of hypoglycemic episodes, but has a disappointingly low success rate in providing persistent insulin independence. Other issues that should be taken into account when considering islet transplantation include the side effects of the immunosuppressive therapy, alloimmunization, and the high costs. Even more importantly, whether islet transplantation prevents the progression of diabetic micro- and macrovascular complications more effectively than strict glycemic control with insulin is largely unknown yet. Until this evidence is provided, pancreatic islet transplantation should be considered as an experimental procedure, whose indications are limited to a highly selected group of type 1 diabetic patients with life-threatening hypoglycemic episodes.