Single-donor islet transplantation in type 1 diabetes: patient selection and special considerations
Authors Tatum JA, Meneveau MO, Brayman KL
Received 11 September 2016
Accepted for publication 3 November 2016
Published 28 February 2017 Volume 2017:10 Pages 73—78
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 3
Editor who approved publication: Professor Ming-Hui Zou
Jacob A Tatum,* Max O Meneveau,* Kenneth L Brayman
Department of Surgery, Division of Transplantation, The University of Virginia Health System, Charlottesville, VA, USA
*These authors contributed equally to this work.
Abstract: Type 1 diabetes mellitus is an autoimmune disorder of the endocrine pancreas that currently affects millions of people in the United States. Although the disease can be managed with exogenous insulin administration, the ultimate cure for the condition lies in restoring a patient’s ability to produce their own insulin. Islet cell allotransplantation provides a means of endogenous insulin production. Though far from perfected, islet transplants are now a proven treatment for type 1 diabetics. However, proper patient selection is critical for achieving optimal outcomes. Given the shortage of transplantable organs, selecting appropriate candidates for whom the procedure will be of greatest benefit is essential. Although many of those who receive islets do not retain insulin independence, grafts do play a significant role in preventing hypoglycemic episodes that can be quite detrimental to quality of life and potentially fatal. Additionally, islet transplant requires lifelong immunosuppression. Antibodies, both preformed and following islet infusion, may play important roles in graft outcomes. Finally, no procedure is without inherent risk and islet transfusions can have serious consequences for recipients’ livers in the form of both vascular and metabolic complications. Therefore, patient-specific factors that should be taken into account before islet transplantation include aims of therapy, sensitization, and potential increased risk for hepatic and portal-venous sequelae.
Keywords: islet transplantation, diabetes mellitus type 1, brittle diabetes, single donor, patient
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