Islet transplantation in type 1 diabetes

H. de Kort, E. de Koning, T. Rabelink, J.A. Bruijn, I. Bajema

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Hanneke de Kort, research fellow1, Eelco J de Koning, associate professor, head of clinical islet transplantation programme234, Ton J Rabelink, professor of medicine, chair of department of nephrology2, Jan A Bruijn, professor immunopathology1, Ingeborg M Bajema, renal and transplantation pathologist11Department of Pathology, Leiden University Medical Centre, 2300 RC Leiden, Netherlands2Department of Nephrology, Leiden University Medical Centre3Department of Endocrinology, Leiden University Medical Centre4Hubrecht Institute, Uppsalalaan 8, 3584 CT Utrecht, NetherlandsCorrespondence to: E J P de Koning e.dekoning{at}lumc.nlAccepted 10 December 2010Summary pointsIslet of Langerhans transplantation is used in a select group of patients with type 1 diabetes with severe glycaemic lability, recurrent hypoglycaemia, and hypoglycaemia unawarenessThe procedure is minimally invasive, with few procedure related complicationsTwo to three islet infusions are usually needed to achieve insulin independenceMost patients need insulin by five years post-transplantation owing to declining graft function; beneficial effects on the frequency of hypoglycaemic episodes and hypoglycaemia awareness remainMost long term complications are related to systemic immunosuppressionThe risk-benefit ratio of islet transplantation should be carefully weighed by the treating physician and the potential recipient, who should be given adequate informationA clinical review in the BMJ in 2001 anticipated that by 2010 transplantation of islets of Langerhans would be the treatment of choice for most patients with type 1 diabetes.1 Currently, islet transplantation is an option for a specific group of patients with type 1 diabetes only—those with severe glycaemic lability, recurrent hypoglycaemia, and hypoglycaemia unawareness. Patients with type 1 diabetes—who must deal with daily subcutaneous insulin injections, regular finger pricks for glucose measurements, and worries about hypoglycaemic episodes and long term complications of diabetes, hope for a cure for their disease and may ask their doctors about islet transplantation. Therefore, doctors who treat such patients should understand the potential benefits of islet transplantation as well as the hurdles that need to be overcome before it is widely used (box 1).Sources and selection criteriaWe searched PubMed, Embase, Web of Science, Cochrane, CINAHL, Academic Search Premier, and ScienceDirect using the keyword “islet transplantation”. We limited our search to the English language and to human studies. We found no randomised controlled trials, and most publications lacked an appropriate control group that was intensively managed by insulin using modern treatment regimens. Data were mainly derived from case series, follow-up …
Original languageUndefined
Pages (from-to)426-432
JournalBritish Medical Journal
Publication statusPublished - 2011

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