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Islet Cell Transplants
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There has been a huge interest of late in
islet cell transplants. Indeed, an immense amount of press has been
generated since researchers in Edmonton, Alberta started transplanting islet
cells (harvested from cadavers) into individuals with Type 1 diabetes.
Although the procedure is innovative and exciting and, importantly, most
recipients have fewer episodes of problematic hypoglycemia, there are, I'm sorry
to say, some very big 'buts:'
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the Edmonton protocol has been used
in a very limited number of patients; hence, experience with it remains limited. |
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almost all islet cell transplant recipients
end up back on insulin within a few years. |
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all of the transplant recipients have to
stay on anti-rejection drugs or they will reject the transplanted cells. |
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certain complications may and indeed,
do occur from both the transplant procedure and the anti-rejection drugs
including:
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blood clots ("partial thrombosis of
the portal vein") |
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bleeding (to the point, on occasion,
of requiring a blood transfusion) |
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mouth ulcers (in almost every single
person) |
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nausea (in half of
recipients) |
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headaches (again, in about
half of recipients) |
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swollen ankles |
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a reduction in white blood
cells (which in theory could make one more prone to infections) |
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worsening of hypertension (high blood
pressure) |
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worsening of dyslipidemia (abnormal
cholesterol and triglycerides) |
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theoretically, one could receive an
islet cell transplant, reject it and then be less able to succeed with a
future transplant (when the technique has been 'perfected') because of a
build-up of antibodies to islet cells. |
This image is from "Columbia Health Sciences."
Several of
the lead researchers from the Edmonton study have published an
article in The Lancet (an
internationally recognized and famed medical journal) wherein they state:
"The procedure can...only be justified in patients at great risk
from...severe recurrent coma or metabolic instability despite compliance
with an optimum insulin regimen." So, no it is not a cure. But
it is a very favourable step forward and hopefully as the technique
improves it will become an increasingly effective, safe and useful
treatment.
The ultimate goal is, of course, to have
an unlimited supply of islet cells available for transplant and for these cells
to be immunologically neutral (which is to say; not being subject to rejection
by the recipient). Most every person with Type 1 diabetes that I have ever met has been
told of an imminent "cure" for diabetes for pretty well as long as they have had
diabetes. Well-meaning friends and relatives call them with the "great
news" about "the cure that they heard about on the radio." And most
people with diabetes that I've come to know have become sceptical of such repeated
"breakthroughs." And I can't blame them for a moment for indeed
they should be sceptical. They've heard it all before. Yet, one day
there will be a cure. No, I don't know when, but I sure do hope that there
will come a time when my services are no longer needed and I have to go looking
for a new job. Hey, maybe I'll go into writing full time.
More information is available at the
Collaborative Islet Transplant Registry and at
University of Alberta islet cell transplant web site.
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