Surgery to place a piece of human pancreas (either from a living related donor, or from a recently deceased organ donor) into a person with Type 1 diabetes has been performed many times over the years. If the pancreas transplant is not rejected, it's quite possible for the recipient to have normal blood sugar levels, and normal glycohemoglobin levels, without any insulin injections. But the surgery itself is complex, and the therapy that's needed to prevent the body from attacking and destroying the transplant is even more complicated. It's been commented by some patients who have had transplants that taking the anti-rejection medications is worse than having diabetes! Generally, pancreas transplants are therefore advised only for people with diabetes with some degree of problems from diabetic complications.
Transplanting a piece of pancreas is not a cure for diabetes, since putting a piece of someone else's pancreas into a person with diabetes doesn't do anything about the autoimmune process that caused the diabetes in the first place. There's still a worry that if the autoimmune process is reactivated, the beta cells of the transplant may be damaged or destroyed.
Many times in the past, a hospital has tried one or two pancreas transplants, but I would strongly advise anyone interested in learning more about this procedure to contact a medical center that have a long track record, with publications that discuss their success (and failure) rate.
Islet Cell Transplantation
Islet cell transplantation (removing the islets which contain the beta cells from a donor pancreas, and then putting these islets into a person with diabetes) is presently undergoing evaluation. As with whole pancreas transplant, the problem of rejection of foreign tissue and prevention of recurring autoimmunity must be solved. Researchers are trying to find ways to induce tolerance--meaning prevention of rejection and autoimmunity--without requiring daily immunosuppressant therapy. Researchers at the Diabetes Research Institute in Miami, Florida, for example, are transplanting donor bone marrow along with islets, and also examining novel drugs that block specific immune system pathways involved with rejection.
Although transplanting islet cells may one day help people with diabetes, this procedure is still in the research stage.
Xenotransplantation is the transplantation of organs or tissue from one species to another. For diabetes, this usually refers to transplanting islet cells from pigs into humans. Insulin from pigs closely resembles human insulin and has been used successfully by people for many years. Proponents of xenotransplantation note that, should human islet cell transplantation prove successful, that there are not enough human pancreases available to help the million people with Type 1 diabetes in the United States. They promote xenotransplantation because of the ready availability of pig islets.
Xenotransplantation brings with it the additional difficulty of hyperacute rejection, in which the host body rejects the transplanted tissue more severely than it would an allograft (tissue from the same species). Scientists are working on ways to encapsulate pig islets to prevent them from being identified by the host's immune system, and thereby protect them from hyperacute rejection and any pre-existing autoimmunity. Xenotransplantation is still in the research stage.
For more information
- This web site:
- At other websites:
- Pancreas transplants:
- Pancreas Transplantation for Patients With Diabetes Mellitus, a Clinical Practice Recommendation from the American Diabetes Association.
- Insulin Free World Foundation, which advocates pancreas transplants
- Deb Butterfield: Curiosity Runs Deep, about the founder of the Insulin Free World Foundation
- Islet transplants:
- Diabetes Research Institute at the University of Miami School of Medicine.
- Pancreatic Islet Transplantation
Original posting 30 Oct 1999
Updated 30 Jan 2005
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