The pros and cons of an islet transplant

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The advantages of the islet transplantation include

1 Freedom from the need for insulin injections 1 Reversal of long-term diabetic complications 1 An end to hypoglycemia and hyperglycemia 1 A return of hypoglycemic awareness

Several risks are associated with islet transplantation. They include the following:

1 Danger of bleeding because heparin is given to prevent clotting of the portal vein for the injection

1 All the risks of the antirejection drugs used for intact pancreas transplantation (which I cover earlier in this chapter), including increased blood pressure, increased blood fats, and decreased kidney function

1 Potential worsening of diabetes-related eye disease, requiring laser surgery

The outcome for islet transplantation isn't nearly as good as intact pancreas transplantation. At one year after surgery, 70 percent of patients don't need insulin injections, but at four years, the number drops to 20 percent. For intact pancreas transplantation, the continued success at four years is 70 percent.

Even partial success in an islet transplant makes a big difference in the quality of life of the patient with diabetes who has severe up-and-down blood glucose or hypoglycemic unawareness.

A few variations on

Three new developments in the transplantation of islets are experimental, just like the original procedure.

1 Microencapsulated islet cells have been used for transplantation. The cells are coated with gum-like materials so that other cells that promote rejection as well as the antibodies that attempt to do the same are prevented from getting to the islets. If this were successful, there would be no need for antirejection drugs.

1 Stem cells, the cells in the body that haven't yet changed for a specific function, have islet transplantation been made to evolve into beta cells. However, scientists are having difficulty generating sufficient numbers of stem cells to eliminate the need for insulin.

1 Animal islets, particularly from pigs, are being evaluated for transplantation into humans. However, the body would try to reject these islets even harder than it tries to reject human islets.

The problems associated with the last two possibilities mean it will be years before doctors and researchers see the benefits of stem cell or animal islet transplantation.

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