About Islet Cell Transplantation: commonly asked questions
• What are Islet Cells?
Islets are groupings of cells in the pancreas. Within these groups are beta cells, which are the cells that produce insulin. The beta cells only make up about 2% of the whole pancreas.
• What is the difference between an Islet Cell Transplant and Pancreas Transplant?
Islet cells are taken from the pancreas of a deceased organ donor. The islets are
separated with a filtration system, processed and purified. They are transferred to a diabetic patient by infusing the cells into a large vein in the liver. The surgeon performs this transplant through a small incision using general anesthesia. Once implanted, the beta cells in these islets begin to make and release insulin.
Even though whole pancreas transplantation has shown to be very successful, it is a major operation with significant risks and complications. Due to very strict selection criteria, only a small percentage of diabetic patients are candidates for whole pancreas transplantation. By offering Islet Cell transplantation, we hope to eventually help a larger group of diabetic patients.
• Will I be insulin – free after the transplant?
It may take up to two months after the transplant to be free from insulin injections. If insulin is required to maintain normal glucose levels, your physicians will discuss a second Islet Cell transplant with you and your family.
• What are the benefits of Islet Cell Transplant?
The primary goal of this study is to achieve insulin-independence in patients with type 1 diabetes. By eliminating the need for insulin injections to maintain normal glucose levels, patients should noticeably reduce the number of life-threatening hypoglycemic episodes and may also decrease the development of diabetes-related complications. Even patients who do not achieve or maintain insulin independence may reduce their insulin requirements and could still decrease or eliminate the number of hypoglycemic events.
• What are the risks to having this Transplant?
The procedure itself may cause mild bleeding and/or blood clots. Risks associated with anesthesia are often dependent upon your age, wellness state prior to the procedure, and the type of anesthesia used. You will be required to take immunosuppressive drugs to prevent rejection after the transplant. These drugs have a wide range of side-effects including mouth sores, gastric irritation, anemia, and hypertension. These drugs may also decrease white blood cells, which can decrease the ability to fight off infections and may increase the risk of cancer.
All benefits and risks will be discussed in full detail by the physicians with you and your family. Each person reacts differently to surgery, anesthesia, and immunosuppressive medications.
• Who qualifies for an Islet Cell Transplant?
Patients with type 1 diabetes and significant hypoglycemic or hyperglycemic events are being considered for this procedure. These individuals are faced with balancing the risk of diabetes complications from hyperglycemia or hypoglycemia with the risk of immunosuppression. Patients with type 1 diabetes who have previously received a kidney transplant may also qualify, since these patients are already on immunosuppression.
• How will I know if I am a consideration for the Islet Cell Transplant?
Our team is looking closely at all type I diabetic patients. If you appear to meet the criteria, we will discuss this treatment for your diabetes with you further. You will be asked to come to clinic at Kinnear Road and meet with the Director of the Islet Cell Transplant Program, Dr. Amer Rajab and our Transplant Endocrinologist, Dr. Elizabeth Diakoff. You will be interviewed by our Pre-transplant coordinator, Dianne Goodrich, RN as well as discuss financial issues with our social work team.
Your work-up will also consist of a day-long visit to the General Clinical Research Center (GCRC) for further evaluation. Details of these visits will be outlined and discussed with you after your initial clinic visit.
• Why is this considered a study?
The larger transplant centers who have been working on animal models for islet cell transplantation have shown great success. Human islet cell transplantation is already proving to change patients’ lives with type 1 diabetes. However, government agencies still consider this procedure experimental until more long-term data shows adequate success rates in both Islet Cell performance and patient survival.
• How will the Islet Cell Transplant be paid?
An attempt will be made to obtain prior authorization from your insurance carrier. The cost of medication, the islet transplant, laboratory studies, screening studies, and follow-up visits will be billed to your insurance company as with any other organ transplant.
References: Pancreatic Islet Transplantation - http://diabetes.niddk.nih.gov/dm/pubs/pancreaticislet/#1 – NIH Publication No. 07–4693 - March 2007