Endocrine Abstracts

Attempts at restoring endogenous insulin secretion by the transplantation of human islet tissue, initially using whole pancreas transplantation, was first reported in 1966. Although there is also a long history surrounding the transplantation of isolated human islets, it was the development and subsequent publication of the Edmonton, glucocorticoid free immunospressive regimen, in 2000, that transformed the use and availability of islet cell transplantation for people with difficult to treat type 1 diabetes mellitus (T1DM). The procedure is now regularly performed in many countries, including active programmes in Europe, the USA and Canada. In the UK it is uniquely available on the NHS, for patients satisfying guidance issued by the National Institute for Health and Clinical excellence (NICE); namely people with T1DM who suffer severe, recurrent and potentially life threatening hypoglycaemia. Whilst insulin independence may be achieved, particularly in patients receiving more than one transplant, the major benefit is resolution of severe hypoglycaemia. International data now show that the percutaneous infusion of islet cells, via the transhepatic approach into the portal vein, can produce graft function rates of up to 80% at 5 years. International outcomes from almost 700 subjects also show that this is associated with >90% recipients free from severe hypoglycaemia at 5 years. Whilst islet cell transplantation has demonstrated impressive clinical outcomes, it is still restricted to a relatively select group of people with T1DM in whom the benefits surrounding the diabetes management outweigh the requirement for life-long immunosuppression. Future developments are focusing on improvements in the procedure, including reducing the immunogenic environment to which the transplanted islets are exposed, increasing the inclusion criteria into whom islets can be transplanted and further research into the impact of islet transplantation on long term diabetes related complications.