Living Donor Islet Cell Transplant

NEW YORK (Reuters Health) - Researchers in Japan have successfully performed a pancreatic islet transplantation to a woman with brittle, insulin-dependent diabetes, for which her mother was the living donor.
As reported Monday in an early online edition of The Lancet, the recipient was a 27-year-old woman with onset of insulin-dependent diabetes at age 15, after she had developed chronic pancreatitis at 4 years of age. The woman had frequent hypoglycemic episodes of which she was unaware.

The donor was a healthy 56-year-old woman who was not obese, had a healthy glucose pattern and insulinogenic index, and lacked autoantibodies to glutamic acid decarboxylase and insulin.
Dr. Shinichi Matsumoto, at Kyoto University Hospital, and colleagues performed a distal pancreatectomy in the donor, in which the pancreatic tail was used for islet isolation by digestion with liberase containing trypsin inhibitors.

The total islet yield of approximately 408,000 islet equivalents was transplanted into the recipient's liver through the portal vein. She had been treated with sirolimus, tacrolimus, basiliximab and infliximab before transplantation.

The mother was discharged 18 days after the operation, at which time her oral glucose tolerance test (OGTT) results were healthy.

The recipient became insulin independent on day 22, and has remained so for the 2 months since transplantation, "with excellent glycemic control." She was released from hospital on day 37 after transplantation, with normal OGTT results.

The authors note that the metabolic effect derived from half a living pancreas was equivalent to that achieved from using two or more whole pancreas isolations from cadavers. "Our successful transplantation might have implications for the ongoing transition of the procedure, from clinical investigation to routine clinical care," Dr. Matsumoto's group proposes.

In a related editorial, Drs. Stephanie A. Amiel and Mohamed Rela at King's College in London suggest that results from a living donor may benefit from the absence of the cytokine storm that occurs with the brain death of a conventional cadaveric donor, as well as reduced cold ischemia and preservation damage to the pancreas, and closer tissue matching.

However, "in societies in which transplantation of cadaveric organs is feasible, the use of living, related donors seems difficult to justify," they add. It is not known what the long-term consequences will be, either for donors or recipients.

- Lancet -

Research

A1c Guidelines from AACE | Benefits seen in Inhaled insulin | Living Donor Islet Cell Transplant
Better Glycemic Control with Exenatide