Insulin Independence Following Isolated Islet Transplantation and Single Islet Infusions

TLDR

The Edmonton group demonstrated insulin independence in seven type 1 diabetes patients using >9,000 IEq/kg of islet mass across two to three transplants, raising questions about whether similar success can be replicated and whether multiple donor transplants are universally required. The study aimed to restore islet function in patients with labile type 1 diabetes and to assess whether insulin independence can be achieved with a single transplant or requires multiple transplants. Nine patients with labile type 1 diabetes underwent islet transplantation using the Edmonton immunosuppressive regimen. All seven patients who completed the protocol achieved insulin independence, with five requiring only a single islet infusion; only one patient lost graft function after nine months, confirming that the Edmonton regimen can achieve insulin independence—often with a single transplant of adequate islet mass.

Abstract

Objective To restore islet function in patients whose labile diabetes subjected them to frequent dangerous episodes of hypoglycemic unawareness, and to determine whether multiple transplants are always required to achieve insulin independence. Summary Background Data The recent report by the Edmonton group documenting restoration of insulin independence by islet transplantation in seven consecutive patients with type 1 diabetes differed from previous worldwide experience of only sporadic success. In the Edmonton patients, the transplanted islet mass critical for success was approximately more than 9,000 IEq/kg of recipient body weight and required two or three separate transplants of islets isolated from two to four cadaveric donors. Whether the success of the Edmonton group can be recapitulated by others, and whether repeated transplants using multiple donors will be a universal requirement for success have not been reported. Methods The authors report their treatment with islet transplantation of nine patients whose labile type 1 diabetes was characterized by frequent episodes of dangerous hypoglycemia. Results In each of the seven patients who have completed the treatment protocol (i.e., one or if necessary a second islet transplant), insulin independence has been achieved. In five of the seven patients only a single infusion of islets was required. To date, only one recipient has subsequently lost graft function, after an initially successful transplant. This patient suffered recurrent hyperglycemia 9 months after the transplant. Conclusions This report confirms the efficacy of the Edmonton immunosuppressive regimen and indicates that insulin independence can often be achieved by a single transplant of sufficient islet mass.