Islet cell transplantation: Current status in the UK

Up to a third of patients with type 1 diabetes have impaired awareness of hypoglycaemia, putting them at a six-fold higher risk of severe hypoglycaemia, requiring third-party assistance. Following the success of a Diabetes UK funded research programme, islet transplantation is centrally funded at seven UK sites. Islet transplantation is indicated for patients with recurrent, severe, disabling hypoglycaemia despite best medical therapy. In most patients, this includes a trial of insulin pump therapy. International data suggest five-year graft survival of between 30-50%, with those patients remaining free from hypoglycaemia and insulin-independence rates of 20-25% at five years. The UK programme is focused on hypoglycaemia protection, and UK data from 24 recipients show a reduction in the frequency of severe hypoglycaemia from 23/patient per year to 0.56/patient per year. The main alternative to islet transplantation is whole pancreas transplantation, which also has a five-year graft survival rate of 50%, but much higher insulin independence rates. However, this is associated with significantly higher surgical morbidity. Islet transplantation is very safe, the main risks being related to immunosuppression. We have a lot of experience with these drugs in solid organ transplantation. The main risk is a 4% excess risk of skin cancers, the majority of which are curable. It is important for hypoglycaemia status to be assessed in all patients with type 1 diabetes, so that those with problematic severe hypoglycaemia can be identified. In these patients, islet transplantation can offer potential normalisation of blood glucose with complete resolution of hypoglycaemia. Copyright © 2012 John Wiley & Sons.