ECD for Islet Transplantation

Abstract

Pancreatic islet transplantation offers a minimally invasive option for type 1 diabetic patients. Before 2000, less than 10 % of the recipients of islet transplantation achieved insulin independency [1]. The introduction of the Edmonton Protocol, however, with a highly improved rate of insulin independency, encouraged us to promote clinical islet transplantation [2, 3]. In the Edmonton Protocol, brain-dead donors were used for islet isolation, and the donors were selected according to the factors that influence the success of islet isolation [4]. Even using the Edmonton Protocol, the results of clinical islet transplantation including a long-term graft survival were far from ideal and were significantly worse than clinical pancreas transplantation (pancreas transplant alone, PTA). The newly designed protocol from Minnesota University by Hering et al. that includes induction therapy with a T-cell-depleting antibody (anti-thymus globulin, ATG) and an inhibitor of tumor necrosis factor-α (TNF-α) achieved successful islet transplantation from a single donor. Short-term and long-term islet graft survivals were shown which were comparable to those in clinical pancreas transplantation (PTA). These results demonstrated that islet transplantation was expected to take the place of solitary pancreas transplantation for the type 1 diabetic patients without renal dysfunction.