Clinical islet transplantation can provide insulin independence in the majority of properly selected type 1 diabetic patients if an adequate transplant islet mass is infused, toxic immunosuppressive drugs such as glucocorticoids are avoided, and allo and autoimmune destruction of transplanted islets is minimized. However, the general requirement for at least two donor pancreases for each islet transplant recipient, suboptimal islet engraftment, a decline in islet function over time, and the lifelong need for immunosuppressive therapy continue to make this procedure unsuitable for the majority of type 1 diabetic patients.
For islet transplantation to become more widely utilized in the treatment of diabetes, the current severe lack of transplantable insulin-secreting tissue must be overcome. To accomplish this, the pancreas donor supply must be increased and in the future, alternative cell sources such as stem cells or animal-derived islets may also become available for transplantation. Furthermore, the efficacy and side effect profile of immunosuppressive agents must continue to be improved to enable consistent islet engraftment and fewer adverse effects in islet recipients. Despite these challenges, the recent progress that has occurred in the area of islet transplantation has reinforced the potential of endocrine cell replacement for the treatment of diabetes and given hope to many diabetic patients that they may one day be free from the risk of secondary complications and the daily burden of insulin injections.
Acknowledgements
Thanks to Dr. James Shapiro, Dr. Edmond Ryan, Dr. Peter Senior and Ms. Sharleen Imes for their valuable input
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