Shinichi Matsumoto, a transplantation specialist from Kyoto University Hospital in Japan, has recently reported successfully reversing a patient’s diabetes by transplanting islet cells from a live donor. “Living-donor islet transplantation should be a new option for severe diabetes, especially for patients with frequent hypoglycemia,” Matsumoto says.
The patient was a 27-year-old woman who had developed insulin-dependent dia-betes at 15 years of age and had subsequently been admitted to hospital to control her hypoglycemic episodes. The donor was her 56-year-old mother .
After the donor underwent a distal pancreatectomy, a total of 408,114 islet equivalents were isolated and immediately transplanted. The procedure is tricky as islet cells have a reputation of being very delicate, as emphasized by islet transplantation expert Stephanie Amiel of King’s College London, UK, “It’s difficult to extract them and keep them healthy.” According to Matsumoto, “The procedure involves surgical removal of half of the donor pancreas, isolation of islets from the resected pancreas, and islet transplantation into the recipient’s liver by drip infusion.”
Only 22 days after surgery, the recipient became insulin independent. No complications were reported, “The donor returned to her job without any change. The recipient is insulin-free and has had no further hypoglycemic episodes,” says Matsumoto.
The procedure itself can be repeated should the islets stop functioning. Anti-apoptopic reagents or anti-inflammatory drugs may also be used during islet isolation or after transplantation to improve islet recovery and survival.
The first successful transplantation of islet cells took place in 2000 and since then approximately 100 people have experienced a rapid reversal in their diabetic condition. However, in these cases, the transplanted islet cells originated from a nonliving donor. Islet transplantation from living donors is believed to be more favorable than those from nonliving cells. “Islet transplantation from a living donor is less invasive for the recipient compared with pancreas transplantation,” says Matsumoto.
This procedure may also address the problem of severe donor shortage, especially in countries such as Japan, where cadaveric organ donation is scarce.