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Islet transplantation: need for a time-out?

Nature Clinical Practice Nephrology volume 4, pages 660–661 (2008)Cite this article

Insulin replacement therapy—in combination with diet and exercise—is the treatment of choice for patients with type 1 diabetes (T1D). The goal of this treatment is to normalize blood glucose levels throughout the day to prevent diabetic complications. Strategies include combined use of long-acting and short-acting preparations, and continuous insulin administration via a pump. Such intensive therapy can, however, cause hypoglycemic events, which are particularly dangerous in patients who do not experience the early warning signs of hypoglycemia.

Pancreatic islet β-cell transplantation has been proposed as an alternative treatment for patients with T1D. This approach has the theoretical advantages of a more physiological pattern of hormone release over insulin injection with a lower incidence of morbidity than whole-pancreas transplantation. However, less than 10% of the 267 islet transplantations attempted during the period 1990–2000 resulted in insulin independence for longer than 1 year.1 A turning point in islet transplantation was reached in 2000, when a steroid-free immunosuppressive regimen based on induction with daclizumab and maintenance therapy with sirolimus and low-dose tacrolimus—the so-called 'Edmonton protocol'—was tested. Insulin independence was maintained over a median follow-up of 1 year in all seven patients with T1D who were treated according to the Edmonton protocol after undergoing islet transplantation from two or three donor pancreases.1 This seminal experience prompted rapid expansion of islet cell transplantation programs worldwide.

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Authors and Affiliations

  1. P Ruggenenti is Director of the Renal Medicine Department, A Remuzzi is Director of the Biomedical Engineering Department and G Remuzzi is Director of the Clinical Research Center for Rare Diseases “Aldo e Cele Daccò” at the Mario Negri Institute for Pharmacological Research, P Cravedi is a Clinical Researcher, Bergamo, Italy.,

    Paolo Cravedi, Piero Ruggenenti, Andrea Remuzzi & Giuseppe Remuzzi

  2. RB Mannon is Medical Director of Transplantation in the Transplantation Branch, NIDDK/NIH, Bethesda, MD, USA.,

    Roslyn B Mannon

Authors
  1. Paolo Cravedi
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  2. Roslyn B Mannon
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  3. Piero Ruggenenti
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  4. Andrea Remuzzi
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  5. Giuseppe Remuzzi
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Correspondence to Giuseppe Remuzzi.

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The authors declare no competing financial interests.

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Cravedi, P., Mannon, R., Ruggenenti, P. et al. Islet transplantation: need for a time-out?. Nat Rev Nephrol 4, 660–661 (2008). https://doi.org/10.1038/ncpneph0961

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