Pancreas and Islet Cell Transplantation Offers Hope for Type 1 Diabetics
Northwestern Transplant Program Offers Cutting Edge Therapies for patients with Severe Diabetes
Millions of Americans suffer from type 1 diabetes, an endocrine disease that occurs when the pancreas does not properly produce the insulin necessary to allow sugar to reach cells and provide the body with energy. Insulin replacement therapy is the standard treatment for type 1 diabetes and is effective for many, however some patients require a more aggressive treatment approach due to serious complications from the disease. Experts at Northwestern Memorial Hospital and Northwestern Feinberg School of Medicine are at the forefront of transplant-based therapies for severe diabetes and are currently offering two procedures, pancreas and islet cell transplantation.
One option for patients with severe type 1 diabetes is pancreas transplantation. When successful, the surgery has the potential to eliminate the symptoms of diabetes. With 33 pancreas transplants in 2010, the Northwestern Memorial program is the largest in Illinois and one of the leading in the country.
“Pancreas transplantation replaces the dysfunctional gland with a new, full functioning pancreas, therefore eliminating the need for insulin therapy,” said Joseph Leventhal, MD, PhD,director of the pancreas transplant program at Northwestern Memorial and associate professor of surgery at the Feinberg School. “The new pancreas will begin producing insulin soon after transplantation.”
Northwestern has been performing pancreas transplants since 1992 with outstanding results that exceed national benchmarks.
Islet cell transplant is an investigational option for diabetics. The minimally invasive radiologic technique infuses working cells that can control blood glucose and possibly eliminate the need for insulin therapy. Islets begin to release insulin soon after transplantation with increased function occurring over time.
“Islet cell transplantation is heralding a new era of cutting edge treatments for diabetes,” said Xunrong Luo, MD, PhD,director of the islet cell transplantation program at Northwestern Memorial and assistant professor of medicine and surgery at the Feinberg School. “While still investigational, the therapy could potentially offer the same benefits of a pancreas transplant without surgery.”
Very few islet transplants are performed in the United States at only a limited number of academic institutions. In 1996, Northwestern researchers performed the first islet cell transplantation in Illinois and have since been at the forefront of this investigational therapy for type 1 diabetes. Investigators are currently enrolling people with severe diabetic control problems in two NIH-supported studies.
“The transplantation is performed under rigorous study protocols and requires state-of-the-art clean room facilities for islet isolation,” said Luo. “Study candidates include people who have significant difficulty avoiding and sensing extremely low blood sugar levels, which can result in life-threatening unconsciousness without warning and frequent disruption to daily activities. Others who may qualify are people with severe diabetes that involves episodes of extremely high blood glucose levels resulting in frequent emergency room visits and hospitalizations.”
While optimistic about the future of pancreas and islet cell transplantation for diabetes, experts caution that the procedures are not suitable for everyone and that islet transplantation is still investigational in nature. Pancreas transplantation also comes with potentially serious risks and requires immune-suppressing drugs following surgery to prevent organ rejection. It is important for doctors and patients to weigh the potential costs against the benefits and to carefully select which patients are suitable for the procedure.
Islet cell transplant does not require surgery and therefore eliminates some risk, however immune-suppressing medications are still necessary and the body can attack the new islet cells just as it did with its own natural islet cells, making the benefits of treatment short lived in some cases.
Since many patients with type 1 diabetes are also faced with severe kidney damage both islet cell and pancreas transplantation are offered in conjunction with kidney transplantation at Northwestern Memorial. Pancreas transplantation is now considered a standard of care procedure offered alone, or as a simultaneous pancreas-kidney transplantation (SPK) or after kidney transplantation (PAK). Among the investigational clinical trials for islet transplantation is islet after kidney (IAK) for patients with type 1 diabetes who have had a successful kidney transplant.
“While pancreas transplantation isn’t a first-line treatment for diabetes, it is a widely accepted option for patients with severe kidney damage, as well as those who struggle with controlling their diabetes and blood sugar levels or often have insulin reactions,” explained Leventhal.
With its multi-disciplinary approach and a dedicated team of nurses, researchers, surgeons and physicians, Northwestern's transplant program continues to be a leader in the treatment of type 1 diabetes. “Under the leadership of Dr. Leventhal and Dr. Luo, our program continues to be at the forefront of bringing the latest treatment options to patients with type 1 diabetes,” said Michael Abecassis, MD, MBA chief of the division of organ transplantation at Northwestern Memorial and dean of clinical affairs at the Feinberg School. “The combined experience of our physicians and nurses allows our program to offer innovative options to patients who can no longer benefit from the standard treatments.”
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