Risks and Benefits of Islet Transplantation

Islet transplantation offers promise, but it still shows risks of complications and loss of islet function over time.

After initiating a new islet isolation and transplant center, National Institutes of Health researchers related their experiences, sharing the islet transplant outcomes of six female type 1s, all with a history of hypoglycemia unawareness and no self-production of insulin (serum C-peptide negative).

These patients received the antirejection drugs daclizumab, sirolimus and tacrolimus-a steroid-sparing combination.

Results showed that all patients noted less frequent and less severe low blood glucose episodes, and 50 percent were insulin-free at one year after transplant. All but one showed serum C-peptide levels indicating continued islet cell insulin-production function.

Two major complications were serious intra-abdominal bleeding and partial portal vein thrombosis (blockage by blood clotting). In addition, recipients frequently developed transient mouth ulcers, diarrhea, edema (fluid retention), high blood cholesterol, weight loss, bone-marrow suppression and other symptoms.

Of the six patients, three discontinued the anti-rejection drugs, two because of intolerable toxicity, such as decreasing kidney function, while still showing islet function, and one because of loss of islet function.

-Diabetes Care, December 2003

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