Is Islet Transplantation a Realistic Therapy for the Treatment of Type 1 Diabetes in the Near Future?
- R. Brian Stevens, MD, PhD,
- Shinichi Matsumoto, MD, PhD and
- Christopher L. Marsh, MD, FACS
Abstract
IN BRIEF
Shapiro and colleagues recently reported a 100% cure rate for type 1 diabetes with their “Edmonton protocol” for islet transplantation. This unprecedented success has caused a groundswell of enthusiasm and an unparalleled effort to replicate their experience. It has also raised questions about the clinical reality of this therapy and sparked a dialog about which patients should benefit from receiving this scarce allocated resource. This article reviews the factors contributing to the Edmonton success and obstacles to immediate and long-term expansion of islet transplantation. The authors argue that use of the two-layered method of pancreas preservation will enable the Edmonton protocol to cure diabetes from single and marginal cadaveric donors. A concerted effort will be required to expedite routing of pancreases to islet processing centers and transplant programs. The long-term success and expansion of islet transplantation will depend on not only safer forms of immunosuppression, but also new sources of islet tissue.
Footnotes
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R. Brian Stevens, MD, PhD, is an assistant professor of surgery in the Department of Surgery, Division of Transplantation at the University of Washington and medical director of the Islet and Cell Processing Laboratory at the Puget Sound Blood Center in Seattle. Shinichi Matsumoto, MD, PhD, is the chief research scientist at the Islet and Cell Processing Laboratory at the Puget Sound Blood Center in Seattle. Christopher L. Marsh, MD, FACS, is an associate professor of surgery and urology in the Department of Surgery and Department of Urology, director of the Kidney/Pancreas/Islet Program, and associate director of the Division of Transplantation at the University of Washington in Seattle.
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Note of disclosure: Dr. Marsh has received honoraria for speaking engagements from Roche Laboratories and research support from Roche, Immunex, Inc., Medimmune, Boeing Co., and Fujisawa. These companies are involved in the development of new immunosuppression strategies for kidney, liver, pancreas, and kidney/pancreas transplant patients.
- American Diabetes Association
