Islet Transplantation at the University of Alberta: Status Update and Review of Progress over the Last Decade

      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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