Islet cell transplants from cadaveric pancreata allow insulin independence.
Two of the 10 patients who achieved insulin independence were restarted on insulin, one at 208 days posttransplant, the other at 356 days, but both are being maintained at low insulin levels (3 units and 6 units, respectively).
Rodolfo Alejandro, MD and colleagues from the University of Miami suggested that by culturing islet cells from cadaveric organs, they may have overcome some of the problems associated with the Edmonton protocol. In 2000, researchers in Edmonton, Canada reported that diabetic patients transplanted with fresh islet cells had achieved good glycemic control and were insulin free. But the use of fresh islets required that prospective recipients live within 2 hours of the hospital.
The 11 patients in the current study, 6 males and 5 females, were ABO-matched to donors. The average patient age was 39, and the mean duration of diabetes was 26 years. All patients received 2 infusions of islet cells directly into their livers. Ten patients achieved immediate insulin independence after the second infusion. Side effects, according to Alejandro, were "compatible with immunosuppressive therapy" and included mouth ulcers.
The favorable results from this small series contrast with another report presented at the Congress by investigators at the National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK). In that study of 6 patients transplanted with fresh islet cells, only 3 achieved insulin independence. Moreover, NIDDK investigator Kristina Rother, MD said the side effects of treatment included "paralyzing fatigue."
While NIDDK remains interested in islet transplantation, Rother cautioned that when the procedure is performed in otherwise healthy diabetics, "it can turn patients with essentially no complaints into patients with debilitating disease." She noted, however, that even in the 3 patients who remain insulin dependent, islet cell transplantation reduced their insulin dosage by 50% or more. "Significant hypoglycemia appears to have been eliminated in all patients," she said.
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|Comment:||Islet cell transplants from cadaveric pancreata allow insulin independence.|
|Date:||May 28, 2002|
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