Editorial
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World J Transplant. Dec 24, 2013; 3(4): 48-53
Published online Dec 24, 2013. doi: 10.5500/wjt.v3.i4.48
Current status of clinical islet transplantation
Andrew R Pepper, Boris Gala-Lopez, Oliver Ziff, AM James Shapiro
Andrew R Pepper, Boris Gala-Lopez, AM James Shapiro, Department of Clinical Islet Transplant Program, University of Alberta, Edmonton T6G 2C8, Alberta, Canada
Oliver Ziff, AM James Shapiro, Department of Surgery, University of Alberta, Edmonton T6G 2B7, Alberta, Canada
Author contributions: Pepper AR and Gala-Lopez B contributed equally to this work designing the research and writing the paper; Ziff O performed bibliographic revision and designed figures; Shapiro AMJ designed the research and revised the final manuscript as senior author.
Correspondence to: AM James Shapiro, MD, PhD, Professor, Director of Clinical Islet and Living Donor Liver Transplant Programs, Department of Clinical Islet Transplant Program, University of Alberta, 2000 College Plaza, 8215-112th St, Edmonton T6G 2C8, Alberta, Canada. amjs@islet.ca
Telephone: +1-780-4077330 Fax: +1-780-4078259
Received: July 26, 2013
Revised: August 16, 2013
Accepted: August 28, 2013
Published online: December 24, 2013
Processing time: 158 Days and 13 Hours
Abstract

Islet transplantation (IT) is today a well-established treatment modality for selected patients with type 1 diabetes mellitus (T1DM). After the success of the University of Alberta group with a modified approach to the immune protection of islets, the international experience grew along with the numbers of transplants in highly specialized centers. Yet, long-term analysis of those initial results from the Edmonton group indicated that insulin-independence was not durable and most patients return to modest amounts of insulin around the fifth year, without recurrent hypoglycemia events. Many phenomena have been identified as limiting factor for the islet engraftment and survival, and today all efforts are aimed to improve the quality of islets and their engrafting process, as well as more optimized immunosuppression to facilitate tolerance and ultimately, better long term survival. This brief overview presents recent progress in IT. A concise historical perspective is provided, along with the latest efforts to improve islet engraftment, immune protection and ultimately, prolonged graft survival. It is apparent that as the community continues to work together further optimizing IT, it is hopeful a cure for T1DM will soon be achievable.

Keywords: Islet transplantation; Type 1 diabetes; Immunosuppression

Core tip: Since the initial inception of the “Edmonton protocol”, phenomenal progress has transpired in the last decade. These milestones were namely due to the implementation of numerous pre-clinical and clinical investigations, testing innovative agents allowing potent immunotolerance with minimal complications as well as alternative transplant sites to overcome limitations inherent to the current intraportal access. As a result nearly 80% of full or partial graft function, out of more than 300 transplants performed to date. As the field of continues to work and progress together, it is foreseeable that a cure for type 1 diabetes mellitus is obtainable in the near future.