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Islet Transplants
Click here to see the latest Abstract by Dr. Sutherland Click here to see the Latest Press release for TOTAL PANCREATECTOMY PLUS AUTOTRANSPLANTATION OF ISLET CELLS REDUCES INTRACTABLE PAIN WITHOUT CREATING DIABETES IN PATIENTS WITH CHRONIC PANCREATITIS Click here to download the PDF file for The Role of Total Pancreatectomy and Islet Autotransplantation for Chronic Pancreatitis. It is Dr. Sutherland's latest article. Dec 11, 2007 How Islet Transplants are Done. Allo islet transplants are performed on adults who have type 1 diabetes who participate in clinical trials performed by the Diabetes Institute for Immunology and Transplantation. Allo means that the islets come from a deceased donor and so the person who has this type of islet transplant (the person with diabetes) must be on immunosuppressive medications their entire life or their body will reject the organ
Historically, the early complications with the exocrine portion of the graft(98% of the pancreas is exocrine tissue), led to the idea of isolating and transplanting the islets in a more easy and non-surgical way. It continues to be deemed a promising approach. Pancreases for islet isolation are usually procured from cadaver donors. With a current islet transplant success rate of only 10%, putting a living donor under surgical risk for islets would generally not be justified (unlike a pancreas transplant). After the Islets of Langerhans, which contain the B-(insulin producing) cells, are separated from the exocrine tissue (islet isolation) by a machine, they may be cultured for 2-3 days before transplantation. Under X-ray guidance islets are injected into the recipient's portal vein. Once in the portal vein, the blood flow and pressure carries the islets to the liver where they encounter small diameter capillaries that cannot be traversed by the islets. In such a mechanical way the islets stay in place, and new capillaries incorporate them in an anatomical form. An islet transplant alone from another person (allograft) is still on its way to be perfected . Islets present a special and not fully understood susceptibility to rejection and to side effects of the immunosuppressants that prevent the cells from functioning or surviving. Furthermore, there is not yet a marker to indicate rejection episodes and thus the opportunity to reverse the immunological attack is missed. At the present islet-kidney transplantation is performed for individuals that need a kidney but cannot have extensive surgery. Although the insulin independence percentage is lower than for pancreas transplant, 1/3 of the recipients have improved glucose control. Islet transplant alone, though, for people whose pancreas is removed to alleviate pain from pancreatitis , can be done with a 75% success. In these cases the recipient's own pancreas is the source of the islets (islet autograft, Iaut.) with no need for immunosuppression. This fact and the appearance of new drugs (now under experimentation) encourage patients, physicians, insurance companies and pharmaceuticals to keep trying. What to Expect in an an auto islet transplant.The type of islet transplants that are performed on patients with chronic pancreatitis (this is called ). The explanation for this is below and more info can be found at http://www.diabetesinstitute.org/diabinst/treatmentspancreatitis/pancreatectomy/expect.html 
During a pancreatectomy and auto islet transplant, surgeons remove the patient's pancreas. Then, they isolate the islets from the pancreas and infuse the islets back into the patient's portal vein in the liver. The islets lodge in the liver or spleen and start producing insulin. About half of patients who have this procedure do not need to take insulin. Our experience indicates that if the patient has had previous surgery on the head or tail of the pancreas, they are more likely to need to take insulin shots after the pancreatectomy and auto islet transplant. Because the patient's own islets are used, they do not need to take immunosuppressive medications after surgery.
From Dr Sutherland office.How do we get the islets out of the same person we're putting them into? Well, the person with chronic pancreatitis is in severe pain and some of them have tried other procedures and, unfortunately, nothing has worked to relieve the pain. So, at some point (determined by the doctor and patient), the person needs to have their pancreas removed. Lots of centers around the country/world can remove a patient's pancreas. However, we are one of the few centers in the world that can remove the patient's pancreas, isolate the islets from their pancreas, and infuse their islets back into them. Why do this? Well, without a pancreas, the person becomes diabetic and must be on insulin for the rest of their life. If we put the islets back in, there's a 50% chance that the person will not be diabetic and will not need to take insulin the rest of their life. (The 50% is based on our most recent outcomes). A 50/50 chance may not seem good; however, consider the fact that if they have their pancreas removed (called a pancreatectomy) somewhere else, there is a 100% chance they will be diabetic. If they have a pancreatectomy and an auto islet transplant here, there's a 50% chance they will be diabetic. Considering all of the acute and chronic complications of diabetes, a 50% chance of not becoming diabetic after having your pancreas removed is pretty darned good. People who want to find out more re: pancreatectomy and auto islet transplants can sure go to the web link I listed above on our DIIT website. The actual procedure is performed by Dr. Sutherland (mostly) and other transplant doctors at the University of Minnesota Medical Center, Fairview. Unfortunately, at this time, they don't have info on the Fairview Transplant website ( www.fairviewtransplant.org) about this procedure. I am going to be working with them to redo their transplant website, but it will take awhile to develop the new info and get it up on their site. If people want to receive more info about getting a pancreatectomy and auto islet transplant, they should call The Transplant Center at 612-525-5115 or 1-800-328-5465 and choose Option #1. Then, they can ask for a packet of information about auto islet transplants.
David E.R. Sutherland, M.D., Ph.D., David E.R. Sutherland, M.D., Ph.D., is Director of the Diabetes Institute for Immunology and Transplantation and Head of the Transplant Division at the University of Minnesota Division of Transplantation. Regarded as athe pioneer of pancreas transplants, Dr. Sutherland and his associates have performed almost 1,700 more than 900 pancreas and islet transplants over the past 40 years during his 30-year quest to perfect a cure for diabetes. Many of the doctors who trained as residents and fellows under his direction have gone on to develop pancreas transplant programs around the world. While his achievements have brought him numerous awards and honors, Dr. Sutherland is known among his patients as a man of great humility who is always available to answer their concerns and who is determined to give back to them the quality of their days.
http://www.diabetesinstitute.org/diabinst/about/team/directors/sutherland.html The Diabetes Institute For Immunology and Transplantation, University of Minnesota Medical School, Department of Surgery, MMC 195, 420 Delaware Street SE, Minneapolis, MN, 55455 Phone: (612) 626-3016 624-8402 Website: http://www.diabetesinstitute.org
Click here for the history of the Auto Islet Transplant
Click Here for FAQ of Auto Islet Transplant
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