Voice of the Diabetic

Voice of the Diabetic

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PANCREAS AND ISLET TRANSPLANTATION

by Vanesa Sutherland

Preface

The Diabetes Institute for Immunology and Transplantation (DIIT) at the University

of Minnesota is devoted to the research and development of better treatments

for diabetes and its eventual "cure." In doing so, the DIIT is constantly

promoting education on pancreas and islet transplants as the only and most physiological

treatment to make individuals with type I diabetes insulin-independent.

With more than 11,000 pancreas transplants performed worldwide since 1966, and

the recognition by the American Diabetes Association (ADA), American Medical

Association (AMA), and numerous insurance companies, pancreas transplantation

has gained acceptance among physicians and the general public. In 1966, the

University of Minnesota established the feasibility of the procedure, training

surgeons and transplant physicians who have founded pancreas transplant programs

nationwide as well as internationally. There are currently 96 pancreas transplant

programs in United States. Even without Medicare coverage, more than 1000 transplants

are being done annually.

More than 1000 pancreas transplants have been done at the University of Minnesota,

nearly 10% of the world's total. The University of Minnesota's program is also

a pioneer in living related donor segmental pancreas transplants, and the only

program that applies this cutting edge procedure routinely before complications

have appeared. More than 100 pancreas transplants were done at the University

of Minnesota in 1998.

The pancreas, a small, elongated organ shaped like a little trout, is located

in the left side of the body, underneath the stomach and extending transversely

through the abdomen. It contains round clusters of cells called Islets of Langerhans

(2% of the pancreas) that are interspersed in the glandular tissue. The latter

tissue accounts for pancreas exocrine function, and helps the digestion process

by releasing enzymes into the intestine. The endocrine function is performed

by specialized cells in the Islets. Those that are responsible for the production

and release of the hormone insulin into the blood are called beta cells. Insulin

allows every cell in the body to use the different sources of energy, such as

fat and glucose, to perform their function. The loss of, or the inability of,

beta cells to adequately produce the insulin needed by the body is called diabetes.

A tremendous advance in treating diabetes was accomplished by Dr. Frederick

Allen in 1917. He pointed out that diabetes was not just a problem with carbohydrate

metabolism, but with protein and fat as well. The total calorie intake had to

be reduced to the minimum that would allow subsistence while minimizing the

acidosis that occurs from metabolism of the three offenders in the absence of

insulin. The dilemma was that patients either died soon after diabetes onset

or tolerated diabetes for a few years until they died of starvation. Dr. Allen's

approach was severely criticized, but, as he noted, dying of diabetes is much

more painful than dying of starvation, and "after all, do we have an alternative

to prolong a diabetic life?" With this treatment Dr. Allen was able to

prolong his patients' lives for a few more years.

Insulin was discovered in Toronto in 1922 by Dr. Frederick Banting. At that

time, insulin was seen as a cure for diabetes; indeed, several patients who

were alive, thanks to Dr. Allen's treatment, were able to use insulin and live

longer than previously expected. With insulin's extensive employment as a treatment,

diabetes was no longer a mortal disease.

Within that same year, the idea was conceived that maintaining normal glucose

levels in the diabetic individual would lead to a quality of life equal to that

of a non-diabetic. Therefore, a standard treatment based on several daily insulin

shots, dietary restrictions, and exercise became the norm. However, despite

insulin treatment, diabetic complications appeared over time. Diabetics treated

with insulin no longer died from diabetic ketoacidosis, but eventually suffered

devastating organ deterioration and, thus, a poor quality of life. Because of

the idea or possibility of insulin-related organ damage, there was a liberalization

in treatment during the 1960s.

In the 1980s several small studies on intensive insulin treatment and complications

were conducted in Europe, with mixed results. In 1983 the United States, the

Diabetes Control and Complications Trial (DCCT) was begun. This was the longest

and first scientifically controlled study on diabetic complications, and confirmed

the earlier notion that tight control is more effective than a liberal regime

in allaying complications. Complications were not eliminated, however, and quality

of life and patient survival for the diabetic individual remain well below that

of the general population. New paraphernalia (disposable syringes, Humulin insulin,

home blood glucose monitors, etc.) and procedures to treat diabetic complications

(like retina photocoagulation), along with a vast and controlled health support

system, have improved the effectiveness of intensive therapy. Tight control,

achieved by three to four shots of insulin daily, adjusted according to four

or five daily glucose determinations, frequent visits to physicians, exercise,

and diet restrictions, can now at least reduce the risk of kidney failure and

blindness. Even with strict control, however, complications are not avoided

entirely.

The downsides of intensive treatment are frequent hypoglycemic episodes (very

low blood sugar), weight gain, and the tremendous investment of time and energy.

The DCCT has shown, on one hand, that a tight control is instrumental to retard

or even avoid some of the most devastating diabetic complications. On the other

hand, some individuals develop some complications despite intensive therapy.

The amount of continuous social resources and effort employed to partially substitute

the failed natural mechanism of insulin regulation is enormous.

There are one million insulin-dependent diabetics (type 1) in America, with

30,000 new cases diagnosed each year. Diabetes is currently the leading cause

of kidney failure and blindness in adults, the leading disease-related cause

of amputation and impotence, and ranks among the most common chronic diseases

in children. One third of all type 1 diabetic individuals have one or more serious

complications.

Pancreas and Islet Transplantation

Historically, pancreas transplants were first done only in conjunction with

a kidney transplant, based on the notion that diabetic individuals would better

stand the rigors of immunosuppression needed to keep the kidney graft if their

diabetes was also corrected. At a time (1960s and 70s) when most physicians

opposed kidney transplants for diabetic patients, a group of doctors from the

University of Minnesota fought the battle. Today many centers perform double

organ transplants to treat diabetic individuals with kidney disease, either

a simultaneous pancreas and kidney (SPK) transplant or sequential transplants,

usually the pancreas after the kidney (PAK). A few centers, including the University

of Minnesota, do pancreas transplants alone (PTA) before kidney disease occurs.

The first human islet transplant was done in 1974, eight years after the first

pancreas transplant at the University of Minnesota. Islet transplantation has

been under continuous development since that time, while pancreas transplants

have become routine.

How Pancreas Transplants are Done

The recipient's own organs are left in place and the new organs are placed in

the lower abdomen or pelvis. Preferably the pancreas goes to blood vessels on

the right side and the kidney, when included, to the left. A whole pancreas

is procured from a cadaver donor, or half pancreas from a living donor. In the

case of a cadaver donor, the duodenum (the part of the small intestine joined

to the stomach) is also transplanted, as the head of the pancreas is intimately

attached to it. In the case of a living donor, the tail of the pancreas is surgically

separated from the head during the procurement operation in the living donor,

and the head remains in the donor, while the tail is transplanted to the recipient.

Bladder-Drained Cadaver Donor Pancreas Transplant

The surgeons first prepare the donated pancreas graft for implantation

into the recipient. Both ends of the cadaver donor duodenum are closed and a

new opening is made. The graft is then attached in three places to the recipient:

1. The portal vein coming from the graft is sewn to the recipient's iliac vein.

(The iliac vein is the main vein that takes blood from the lower half of the

body back to the heart.)

2. The pancreatic arteries of the donor pancreas are sewn to a graft of the

donor's iliac artery, which is then sewn to the recipient's iliac artery. (The

iliac artery is that artery which supplies the lower half of the body with blood

from the heart.)

3. For pancreas-alone transplants, the duodenum's new opening is usually sewn

into the recipient's bladder, as shown above. The bladder then receives the

exocrine pancreas secretions (enzymes). Alternatively, the graft duodenum can

be sewn to the recipient's intestine, as shown below (enteric drained). This

is now usually done when the patient also receives a same donor kidney. There

are different advantages and drawbacks to each technique. In the case of a living

donor segmental transplant, there is no duodenum and the duct of the pancreas

is sewn directly to the bladder or bowel, depending on the technique chosen.

The first two attachments establish blood flow to the pancreas, allowing insulin

release. The third one allows the exocrine enzymes (and lipase) to be drained.

When drained into the bladder, the urine is tested regularly for amylase levels.

Low amylase excretion is a good marker of a pancreas graft rejection episode

needing treatment, particularly for pancreas alone grafts. Serum amylase and

lipase may also increase during rejection, but are less specific markers than

urine amylase.

In the presence of a same-donor kidney graft an increase in blood creatinine

is a good parameter of rejection that is probably affecting both organs. Thus

bladder drainage is less important for SPK transplants and enteric drainage

can be used from the beginning.

Enteric Drained Cadaver Donor Pancreas Transplant

Drainage into the bladder can lead to some urinary tract problems

in about 10% of recipients due to irritation from sutures or pancreatic enzymes.

The recipient may then need to undergo additional surgery in which pancreas

graft drainage is switched to the intestine.

The surgical complication rate leading to graft loss after the transplant has

been 9%. No fatalities during the actual surgery have occurred.

Living Donor Segmental Pancreas Transplant

How Islet Transplants are Done

Historically, the early complications with the exocrine portion

of the graft (98% of the pancreas is exocrine tissue), led to the idea of isolating

and transplanting the islets in an easier and non-surgical way. It continues

to be deemed a promising approach.

The pancreas is procured from a cadaver donor (due to a current islet success

rate of only 10% at one year, it is preferable to use cadaver donors). After

the Islets of Langerhans, which contain the insulin-producing Beta-cells, are

separated from the exocrine tissue (islet isolation) by a machine, they may

be cultured for two to three days before transplantation. Under X-ray guidance,

islets are injected into the recipient's portal vein. Once in the portal vein,

the blood flow and pressure carries the islets to the liver where they encounter

small-diameter capillaries which cannot be traversed through by the islets.

Thus, the islets are physically lodged in place, and new capillaries grow to

incorporate them in an anatomical form.

Islet Allograft Procedure

An islet transplant alone from another person (allograft) is

still being perfected. Islets present a special and not-fully-understood susceptibility

to rejection and to immunosuppressant side effects that may prevent the cells

from functioning or surviving. Furthermore, there is not yet a marker to indicate

rejection episodes and, thus, the opportunity to reverse the immunological attack

is missed.

Currently, islet-kidney transplantation is performed for individuals that need

a kidney but cannot have extensive surgery. Although the insulin independence

percentage is lower than for pancreas transplants, one-third of the recipients

have improved glucose control.

Islet transplantation alone, though, for people whose pancreas is removed to

alleviate pain from pancreatitis, can be done with a 75% success. In these cases

the recipient's own pancreas is the source of the islets (islet autograft, 1-aut)

with no need for immunosuppression. This fact, and the development of new drugs

(now under investigation), encourages patients, physicians, insurance companies

and pharmaceuticals to keep trying.

What Can Pancreas or Islet Transplant Achieve?

A successful pancreas transplant recipient does not need to inject insulin or

continuously monitor glucose. The new pancreas automatically adjusts the amount

of insulin needed. Hyperglycemia or hypoglycemia (diabetic syndrome) is eliminated.

It is important to take into account the graft survival rates according to the

kinds of organs transplanted and the sequence in which they are transplanted.

For example:

1. A person who suffers from diabetes and has developed kidney failure may prefer

to become insulin-independent and dialysis-free in one surgery by undergoing

simultaneous pancreas and kidney (SPK) from a cadaver or living donor if health

allows extensive surgery. If extensive surgery is contraindicated, simultaneous

islet and kidney (SIK) transplant from a cadaver donor is a good option.

2. A diabetic individual with a previous kidney graft, or an individual with

the opportunity to receive a kidney from a living donor, can proceed first with

the kidney and then wait for a cadaver pancreas or islet [pancreas-after-kidney

(PAK) or islet after kidney (IAK)]

3. Diabetic individuals who do not need a kidney but want to prevent complications

from diabetes or individuals who suffer frequent hypoglycemia episodes or serious

problems controlling diabetes may decide to have a pancreas transplant alone

(PTA). In the case of SPK or SIK from the same donor and PAK or IAK from different

donors, the decision implies that kidney transplant (and immunosuppressive drugs)

is preferable to dialysis and the further surgery to add the pancreas is preferable

to remaining diabetic. In the case of PTA, an individual must make an assessment,

based on medical findings, of the future risk of diabetes and the burden of

tight control versus the future risks of taking drugs. Below is a table with

the recent insulin independent percentages a year after transplant according

to categories :

Category

%

Insulin-free @ 1 year

Longest

insulin independence

Year

of first transplant

SPK

86%

18 years

1966

PAK

83%

17 years

1978

PTA

75%

16 years

1970

IK

10%

4 years

1974

I-Aut.

75%

12 years

1977

In the past, half of the SPK transplant functioned for more

than 14 years, while for PAK and PTA grafts half functioned for more than five

to six years. With the new anti-rejection protocols we expect the proportion

of grafts functioning long-term to increase. The effect of a pancreas transplant

on diabetic secondary complications, when performed after the complications

have already appeared or have been present for some time, varies. Early and

mild neuropathy is completely reversed, while advanced neuropathy is improved

in about half the cases and stabilized in the rest; early nephropathic (kidney)

lesions are reversed after five to ten years, even in the presence of nephrotoxic

immunosuppressants. Retinopathy stabilizes after three years post-transplant.

Cardiac and gastric function appear to improve. Cholesterol and triglyceride

levels improve.

Pancreas Transplant

When done before complications occur

or when they are not severe.

* Abnormal glucose level

* Neuropathy

* Retinopathy

* Nephropathy

* Cardiovascular disease

* Diet restrictions and daily monitoring

Immune System and Immunosuppression

The immune system is in charge of protecting the integrity of our bodies. In

doing so, it has developed several mechanisms to eliminate everything that is

not recognized as part of the original genetic message encoded in our DNA. Anything

not recognized as "self" is meant to be allowed no more than a temporary

stay in our bodies. There are different ways and levels to protect us.

Externally, skin acidity, hair, and body fluids prevent some

pathogens from entering the body. Internally, the immune system acts at cellular

and molecular levels in a hierarchical and specialized fashion. First, the foreign

substance (antigen) is recognized as non-self (after being degraded into peptides

by macrophages). Second, an attack is organized to eliminate the offender. A

set of inherited proteins called the Major Histocompatibility Complex (MHC)

or Human Leukocyte Antigens (HLA) are expressed on the surface of all cells

and contain genetically specific information about our tissue. Our macrophages,

when presented with foreign material, use the MHC to help signal other cells

called lymphocytes, (a type of white blood cell, T-lymphocytes and B-lymphocytes)

to initiate the attack specifically against what is foreign. If what is foreign

is an allograft with a different set of MHC proteins (transplant antigens),

the donor macrophages can directly signal the recipient's T- and B-lymphocytes

to begin an attack without going through the recipient's macrophages.

The immune system has two main characteristics: 1. Memory. A second exposure

to the antigen reactivates the T- and B-lymphocytes with the rapid production

of pre-formed antibodies to efficiently combat the invader; and 2. Specificity.

The immune system directs an action toward a particular antigen. In some cases,

the immune system does not work properly and attacks one's own cells in a specific

organ because the genetic information is not recognized as self (autoimmunity).

For example, type 1 diabetes is the result of an attack of the immune system

against its own pancreatic insulin-producing Beta-cells. Other examples of autoimmunity

are psoriasis and rheumatic fever.

To protect non-self organs (the transplanted grafts) from an immunological attack

(rejection), the daily oral use of drugs that impair the body's immune system

action is required. Presently, drug specificity (action directed just to block

the attack to the organ transplanted) is not high, so the organ recipient is

generally more susceptible to infections. Fortunately, people have been exposed

to several pathogens before using immunosuppression, and once exposed to the

same pathogens after the transplant, the immunological memory will require less

energy for the immune system to act.

The percentage of grafts lost to infections for all recipient categories (SPK,

PAK, PTA) is 4%. After the transplant, recipients usually take three different

immunosuppressants, as well as antiviral and antifungal drugs, two or three

times a day, and undergo weekly lab tests during the first three months post-

transplant. After that, immunosuppressant doses are tapered down and, if there

are no rejection episodes, Prednisone (one of the three immunosuppressants),

is stopped. The antifungal and antiviral drugs are also stopped after about

three months. Medication is reduced to twice a day and frequency of laboratory

tests are eventually reduced to once a month. The probability of rejection episodes

is highest during the first six months, but in most cases can be reversed with

temporary increase in dosage, and intravenous administration of anti-rejection

drugs.

The figure below shows the side effects of different drugs (circles), the side

effects shared by two or more drugs (superimposed areas), and the general side

effects of immunosuppression (rectangle encompassing circles). There are some

important things to note:

1. Not everyone suffers the same side effects, and over time, doses can be adjusted

or medications can be changed.

2. For reasons that are not clear, pancreas recipients experience fewer malignancies

(like skin cancer and lymphoma) than other organ recipients. New protocols and

tests allow stopping of Prednisone, thus avoiding its side effects.

Who is a Candidate?

1. Type 1 diabetics who need a kidney or other organ transplant

and will be on immunosuppressants, or people who are already taking immunosuppressants

for other reasons (autoimmune disease) should have a pancreas or islet transplant.

2. People with difficulty controlling diabetes, who experience

frequent hypoglycemia or hyperglycemia or those with a predisposition to certain

serious complications are also candidates. Also, those who want to prevent diabetic

complications and assume the risks of immunosuppression rather than manage diabetes

can be considered.

3. In people with heart disease, a complete evaluation is necessary

before the transplant. Some cardiac anomalies can be fixed; if not, pancreas

transplant surgery may not be recommended.

4. Blindness is not a contraindication for the transplant since

quality of life will be improved by not having to manage diabetes after a successful

transplant.

5. Most PTA recipients have been between 18 and 58 years old,

but a small number of pancreas transplants have also been done in pediatric

patients whose lives were threatened or disrupted by diabetes.

The Average Cost and Length of Hospital Stay

Most insurance companies cover the procedure and the drugs, particularly for

those who also need or have had a kidney transplant. In the case the insurance

company initially refuses coverage, the patient is encouraged to establish a

dialogue with her/his insurance company. The transplant center physicians can

provide supporting data for the insurance company. Medicare will cover SPK at

selected centers soon, and drugs are covered for the first three years.

Category

Average

Charge

Average

Hospital stay

SPIK

$120,000

14 days

PTA

$80,000

9 days

lK

$80,000

9 days

I after K

$20,000

2 days

I-Auto

$60,000

10 days

Making Contact

If you have seriously decided to explore pancreas or islet transplant as a better

treatment for diabetes, you should make an appointment with a transplant surgeon

to be evaluated.

First, you will be oriented in detail about the process by a transplant nurse

in the transplant center. After that, a transplant physician will discuss with

you which modality is most appropriate for you (SPK, PTA, PAK, IK, IAK) and

the possibility of a living donor kidney and/or pancreas vs. being placed on

a waiting list for a cadaver donor organ. Several tests must be performed as

a part of a complete work-up to better assess your general health status as

well as to determine your tissue or HLA type for matching. In the case of a

potential living donor, the donor will also be carefully instructed of the risks

and will undergo several tests to determine whether or not the candidate will

retain enough organ function to sustain his or her own health as well as how

suitable the organs considered are for the recipient..

Cadaver and/or Living Donor

The University of Minnesota started offering segmental pancreas transplants

(half a pancreas) from living related donors in 1979 when the rejection rate

for organs from cadaver donors was significantly higher. Since then, the results

achieved with cadaver-donor pancreas grafts have dramatically improved and the

success rates are close to that of living-donor pancreas transplant. More than

100 segmental pancreas transplants have now been done from living donors but

the emphasis has been changed to those in need of both a kidney and pancreas

in order to avoid dialysis or for those hard to match. Of 25 kidney and pancreas

living-donor transplants done during 1994-98, all the recipients are alive,

24 have functioning kidneys (96%) and 21 (84%) have a functioning pancreas.

All of the living donors are alive, but some have been treated for complications,

such as fluid collection (3) or abscesses (1). In overweight donors, some have

developed abnormal glucose tolerance, so thin donors are preferred.

A recipient ideally is matched for two things with either a living or cadaver

donor:

1. The donor and recipient should be ABO compatible. This means

that the recipient and donor have either the same blood type or a compatible

blood type. For instance, an 0 individual can always be a donor to the other

blood types while he or she can usually only receive type 0 blood or organs.

2. They share one or more of the six HLA antigens that are taken

into account (two each in regions A, B, and DR). Matching reduces the incidence

of rejection episodes as well as the probability of graft failure from rejection,

and in the long term is associated with lower doses of immunosuppressive drugs.

The table below shows the incidence of graft failure from rejection according

to number of HLA mismatches (out of six) between a cadaver donor and recipient.

As is evident, matching is more important for a pancreas done alone than for

one done with a kidney. The results with living donors are better regardless

of match.

SPIK Mismatch

Graft Loss

PTA Mismatch

Graft Loss

0

none

0

none

1

2%

1

10%

2-5

4%

2-5

20%

6

10%

6

40%

How Does The Waiting List Work?

Your transplant center will enroll you in a nationwide central database which

has access to the information on all the prospective recipients. The list is

dynamic and the time you wait for a cadaver donor transplant depends on:

1. How long you have been on the list.

2. Your blood type: people with blood type 0 will wait the longest

due to the fact that more than half of the population is blood type 0. A person

with type 0 can only receive blood type 0, though they can be donors to other

blood type.

3. Your HLA type: certain antigens are more common than others,

so you will obtain a good match sooner if you have several common antigens.

4. Your level of antibodies formed to potential donors. Previous

blood transfusions, transplants, or pregnancies can cause formation of antibodies

to other individuals, increasing the probability you will be immunologically

reactive to possible donors.

The tissue and blood type of every cadaver donor are matched with the prospective

recipient list and the offer is made based on a combination of matching and

waiting time. The donor organs are first offered locally, then regionally, and

last, nationally. The people listed are ranked according to best match and longest

time in the list. A perfect match has the highest priority and if there is more

than one goes to the person waiting the longest. If there are no perfect matches,

waiting time is given priority and the organ is offered to the ones waiting

the longest with the best match. When a high antibody person has a negative

crossmatch (nonreactive), she/he is given priority because of the low chance

to get a suitable match in the future. The organ is offered for the patient

through the transplant center where the prospective recipient is enrolled, and

if the surgeon considers it a good offer the recipient is called. Once accepted,

a final crossmatch is done to confirm that the recipient is not reactive to

the donor.

The average waiting time for a SPK or SIK is 18 months for blood type 0 individuals,

and 12 months for the rest; for PTA and PAK or islets after kidney it is eight

months. Individual waiting time can be longer or shorter depending on the factors

mentioned above. Recipients with living donors avoid waiting time.

Perhaps the most important and comprehensive indicator of the

effectiveness of pancreas and islet transplant is how the recipients feel about

it. There can be side effects from the immunosuppressants, and some patients

have infections post-transplant, such as CIVIV, bladder irritation, or dehydration

due to the pancreas' exocrine enzymes being excreted through the bladder. However,

nearly all recipients express satisfaction with the transplant due to more flexibility

in their daily life and experience a better emotional and psychological attitude.

Sexual and overall satisfaction is well above that of kidney-alone recipients,

and close to general population. Pregnancy may be undertaken with success but

should be carefully monitored by the recipient and the physician. Results from

a multi-center study reveal that the recipients gave birth to babies with the

same rate of complications as the general female population, although some complications,

like rejection episodes or loss of a graft were registered.

Names of donors and recipients will be provided upon request if you have questions

about the experience.

Summary and Conclusions

1. Pancreas and islet transplantation has developed through

the combined endeavors of physicians, health scientists, pharmacists, governmental

institutions, private insurance companies, patients and their families, thus

transforming the individual and social reality of diabetes. Technology, institutional

development and societal maturation reach an historical peak in making possible

a better treatment for diabetes.

2. Presently, pancreas transplantation has a success rate of

over 80% in patients who also get a kidney transplant (SPK and PAK), and over

70% in those who only need a pancreas (PTA). It dramatically increases day-to-day

quality of life, can prevent diabetic secondary complications, and may reverse

some. The DCCT showed that tight glucose control makes a difference in respect

to diabetic complications. Tight control is very hard to achieve short of a

pancreas transplant, and transplantation has emerged as a safe, flexible and

very effective treatment.

3. Immunosuppressive drugs are used: a) To force the recipient's

system to accept the transplant (minimize the body's ability to reject); b)

To prevent recurrence of diabetes (as diabetes is an autoimmune disease); In

addition, c) Immunosuppressants have to be taken daily to prevent rejection.

There are side effects associated with them, and it is their proper management

over time that makes the difference in the delicate balance between side effects

and rejection. d) New, more specific drugs are on the market or in investigational

stage. e) Tactics of safe immunosuppression are: 1. Stop prednisone six months

post-transplant, 2. Reduction of all drug doses over time, and switch drugs

according to side effects, and 3. Use best HLA match combinations.

4. Although less successful than pancreas transplantation (but

with a lower complication rate), islets are recommended for people who cannot

have or want to avoid extensive surgery. Islet function may be inhibited by

some immunosuppressants, and islet transplantation could profit by introduction

of new drugs. The facts that islet autotransplantation has a 75% success rate

in preventing diabetes after pancreatectomy for pancreatitis in non-diabetic

recipients, and that there are a few diabetic individuals insulin independent

for more than four years after islet allografts, encourage scientists and patients

to continue trying.

5. Eventually, encapsulated islets (human or animal) or a vaccine

or genetic engineering may cure diabetes without the need for immunosuppressants.

Perhaps something else that we are not able to imagine today will do it. According

to experts, a more safe and effective treatment than transplantation is not

around the corner. Supporting the investigational alternative treatments to

diabetes is the gift of today's man to the man of the future in the same way

that we have received our gifts from the past. But certainly with a limited

extent of life, the today's present for today's man is having transplantation

as an option.

Future

There are not enough human organs to offer pancreas or islet transplantation

to all diabetics. One way to overcome the organ shortage is xenotransplantation

(transplanting islets from one species to another), and the Diabetes Institute

is actively involved in research on this topic. The Diabetes Institute receives

generous donations to support these and other studies from people who firmly

believe that life is more than mere survival...

About The Author

Vanesa Sutherland holds a BA in Economics; a diploma in Finance; and a MS in

Artificial Intelligence. She became diabetic at age four, and experienced several

secondary complications from diabetes. In 1995, she received a kidney and half

a pancreas from her mother. Vanesa volunteers part of her time to the Diabetes

Institute for Immunology and Transplantation.

Contact the Institute (located at Fairview-University Medical Center) at: Box

193, 420 Delaware Street SE, Minneapolis, MN 55455; telephone: (612) 626-2101;

website: http://www.DiabetesInstitute.org For more information about transplantation,

contact Fairview-University Medical Center, Transplant Unit; telephone: 1-800-328-5465.

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