Abstract
The general perception of islet transplantation among the diabetes community is somewhat
negative, as insulin independence was maintained in only a small minority and there
are fears about the safety of lifelong immunosuppression. There has been substantial
progress in refining the islet transplant procedure to enhance its safety, reduce
the toxicity of immunosuppression and improve long-term graft function. Longer-term
follow-up studies have clarified the indications for islet transplantation; frequent,
severe hypoglycemia, hypoglycemia unawareness and glycemic lability; facilitated informed
consent and provided a framework for more realistic expectations, and suggest beneficial
effects on microvascular complications. One hundred thirty-eight individuals have
undergone islet transplantation at the University of Alberta over the last 12 years.
Of these, 109 (79%) have full or partial graft function. Patient survival is 96% with
no deaths due to transplantation. Three subjects have been hospitalized because of
severe opportunistic infection and 3 have progressed to require renal replacement
therapy. Current protocols are able to achieve insulin independence rates of 60% beyond
4 years. Safer and more effective islet transplantation, along with refinements in
immunosuppressive therapy, make islet transplantation a more attractive option for
a subset of persons with type 1 diabetes who suffer from frequent, severe hypoglycemia,
lability and/or hypoglycemia unawareness, and resulting in excellent glycemic control
and freedom from hypoglycemia.
Résumé
L’opinion générale de la communauté diabétique sur la transplantation d’îlots est
quelque peu négative, comme l’insulino-indépendance est maintenue par un petit nombre
seulement et qu’il y a des craintes concernant l’innocuité de l’immunosuppression
permanente. Des progrès considérables quant au raffinement de la technique de transplantation
d’îlots ont eu pour effet d’améliorer son innocuité, de réduire la toxicité de l’immunosuppression
et d’améliorer le fonctionnement du greffon à long terme. Les études de suivi à plus
long terme ont précisé les indications de la transplantation d’îlots (hypoglycémie
grave et fréquente, ignorance de l’hypoglycémie et instabilité glycémique), facilité
le consentement informé et fourni un cadre pour des attentes plus réalistes, et elles
laissent entrevoir des effets bénéfiques concernant les complications microvasculaires.
Cent trente-huit individus (138) ont subi une transplantation d’îlots à l’Université
de l’Alberta au cours des douze dernières années. Parmi eux, 109 (79 %) ont un fonctionnement
du greffon complet ou partiel. La survie des patients est de 96 % sans décès attribués
à la transplantation. Trois (3) sujets ont été hospitalisés en raison d’infection
opportuniste grave et 3 ont évolué vers la thérapie de remplacement rénal. Les protocoles
actuels peuvent atteindre des taux d’insulino-indépendance de 60 % au-delà de 4 ans.
Une transplantation d’îlots sécuritaire et plus efficace de même qu’un raffinement
dans le traitement immunosuppresseur font de la transplantation d’îlots une option
plus attrayante pour un sous-ensemble de personnes ayant un diabète de type 1 qui
souffrent d’hypoglycémie grave fréquente, d’instabilité glycémique ou d’ignorance
de l’hypoglycémie, et entraînent une excellente maîtrise glycémique et l’absence d’hypoglycémie.
Keywords
Mots clés
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Article Info
Publication History
Accepted:
January 3,
2012
Received in revised form:
January 3,
2012
Received:
December 16,
2011
Identification
Copyright
© 2012 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.
