Has Time Come for New Goals in Human Islet Transplantation?
Version of Record online: 29 APR 2008
© 2008 The Authors Journal compilation © 2008 The American Society of Transplantation and the American Society of Transplant Surgeons
American Journal of Transplantation
Volume 8, Issue 6, pages 1096–1100, June 2008
How to Cite
Lehmann, R., Spinas, G. A., Moritz, W. and Weber, M. (2008), Has Time Come for New Goals in Human Islet Transplantation?. American Journal of Transplantation, 8: 1096–1100. doi: 10.1111/j.1600-6143.2008.02214.x
- Issue online: 30 MAY 2008
- Version of Record online: 29 APR 2008
- Received 24 October 2007, revised 8 February 2008 and accepted for publication 14 February 2008
- Islet assessment;
- islet blood flow;
- islet graft;
- islet transplantation;
- islet viability;
- kidney transplantation
The enthusiasm regarding clinical islet transplantation has been dampened by the long-term results. Concerns about the associated risks of life-long immunosuppression and the striking imbalance between potential recipients and available donor pancreata warrant changes in some of the current goals.
Islet transplantation will never be a cure of type 1 diabetes in the majority of patients with no secondary complications, but is a valid option for a limited number of patients with brittle diabetes waiting for an organ or after organ transplantation. Furthermore, insulin independence should not be the main goal of islet transplantation, but avoidance of severe hypoglycemia and good glycemic control, which can be achieved with a relatively small functional beta-cell mass. Therefore, initially one islet infusion is sufficient. Retransplantation at a later time point remains an option, if glucose control deteriorates.
Efforts to improve islet transplantation should no longer focus on islet isolation and immunosuppression, but rather on the low posttransplant survival rate of islets caused by activation of the coagulation pathway and the limited oxygen delivery to the islets. Transplantation of smaller islets be it naturally small or size tailored reaggregated islets has the potential to facilitate these processes.