Clinical Review

Islet transplantation in type 1 diabetes

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d217 (Published 21 January 2011) Cite this as: BMJ 2011;342:d217
  1. Hanneke de Kort, research fellow1,
  2. Eelco J de Koning, associate professor, head of clinical islet transplantation programme234,
  3. Ton J Rabelink, professor of medicine, chair of department of nephrology2,
  4. Jan A Bruijn, professor immunopathology1,
  5. Ingeborg M Bajema, renal and transplantation pathologist1
  1. 1Department of Pathology, Leiden University Medical Centre, 2300 RC Leiden, Netherlands
  2. 2Department of Nephrology, Leiden University Medical Centre
  3. 3Department of Endocrinology, Leiden University Medical Centre
  4. 4Hubrecht Institute, Uppsalalaan 8, 3584 CT Utrecht, Netherlands
  1. Correspondence to: E J P de Koning e.dekoning{at}lumc.nl
  • Accepted 10 December 2010

Summary points

  • Islet of Langerhans transplantation is used in a select group of patients with type 1 diabetes with severe glycaemic lability, recurrent hypoglycaemia, and hypoglycaemia unawareness

  • The procedure is minimally invasive, with few procedure related complications

  • Two to three islet infusions are usually needed to achieve insulin independence

  • Most patients need insulin by five years post-transplantation owing to declining graft function; beneficial effects on the frequency of hypoglycaemic episodes and hypoglycaemia awareness remain

  • Most long term complications are related to systemic immunosuppression

  • The risk-benefit ratio of islet transplantation should be carefully weighed by the treating physician and the potential recipient, who should be given adequate information

A clinical review in the BMJ in 2001 anticipated that by 2010 transplantation of islets of Langerhans would be the treatment of choice for most patients with type 1 diabetes.1 Currently, islet transplantation is an option for a specific group of patients with type 1 diabetes only—those with severe glycaemic lability, recurrent hypoglycaemia, and hypoglycaemia unawareness. Patients with type 1 diabetes—who must deal with daily subcutaneous insulin injections, regular finger pricks for glucose measurements, and worries about hypoglycaemic episodes and long term complications of diabetes, hope for a cure for their disease and may ask their doctors about islet transplantation. Therefore, doctors who treat such patients should understand the potential benefits of islet transplantation as well as the hurdles that need to be overcome before it is widely used (box 1).

Sources and selection criteria

We searched PubMed, Embase, Web of Science, Cochrane, CINAHL, Academic Search Premier, and ScienceDirect using the keyword “islet transplantation”. We limited our search to the English language and to human studies. We found no randomised controlled trials, and most publications lacked an appropriate control group that was intensively managed by insulin using modern treatment regimens. Data were mainly derived from case series, follow-up …

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