ABSTRACT
Islet transplantation restores endogenous insulin secretion in individuals with type 1 diabetes by infusing insulin-secreting islet cells, isolated from cadaveric pancreata, into the liver.1 The immune mediated destruction of insulin-secreting beta cells within pancreatic islets that occurs in type 1 diabetes results in an almost complete loss of endogenous insulin secretion, making these individuals completely dependent on exogenous insulin for their survival.2 The benefits of “in tensive” glucose control have been clearly demonstrated in this group of patients.3 However, the primary limitation of intensive insulin therapy is an increased risk of hypoglycemia.4 This risk is particularly high among patients with long-standing diabetes and is often accompanied by increased glycemic lability which occurs when insulin doses do not precisely match physiologic requirements. A variety of therapeutic options have emerged to try to mimic “physiologic” insulin secretion, such as insulin analogues, continuous insulin infusion pumps and continuous glucose monitoring. For people at particularly high risk of severe hypoglycemia and glycemic lability, restoring endogenous insu lin secretion by whole pancreas or pancreatic islet transplantation has several potential advantages over exogenous insulin therapy, including normal to near-normal blood glucose control, the possibility of insulin independence and of reduced secondary complications of diabetes. However, as with any transplant therapy, the potential benefits must be carefully weighed against the underlying risks of the procedure and of chronic immunosuppression.
