open access

Vol 9, No 5 (2020)
Review paper
Published online: 2020-09-17
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Beta cell replacement therapy

Justyna Gołębiewska, Bogumił Wolnik, Michał Hoffmann, Piotr Witkowski, Tomasz Stefaniak, Alicja Dębska-Ślizień
DOI: 10.5603/DK.2020.0035
·
Clinical Diabetology 2020;9(5):344-355.

open access

Vol 9, No 5 (2020)
REVIEW ARTICLES
Published online: 2020-09-17

Abstract

Beta cell replacement therapy is currently the only treatment method that allows restoration of physiological endogenous insulin secretion in the amounts corresponding to the current body requirements. Beta cell replacement options available for highly selected patients with brittle type 1 diabetes include solid- -organ pancreas and islet transplantation. Beta cell replacement therapy may be offered to patients with both good kidney function and renal failure. In progressive renal failure, beta cell transplantation may be performed simultaneously with kidney transplantation or afterwards. Islet autotransplantation is offered to patients submitted to total pancreatectomy. In patients with brittle type 1 diabetes who continue to experience life threatening severe hypoglycaemia episodes despite optimized insulin therapy, beta cell replacement helps improve hypoglycaemia awareness, thus reducing the risk of severe hypoglycaemia episodes, facilitates blood glucose control with normalization of haemoglobin A1c (HbA1c) level, and reduces microvascular disease progression. In patients undergoing total pancreatectomy, infusion of the patient’s own islets isolated from the removed pancreas prevents blood glucose level excursions and reduces the risk of surgically- -induced diabetes. In this article, we review the current indications and contraindications to beta cell replacement, expected benefits, and possible complications of beta cell transplantation.

Abstract

Beta cell replacement therapy is currently the only treatment method that allows restoration of physiological endogenous insulin secretion in the amounts corresponding to the current body requirements. Beta cell replacement options available for highly selected patients with brittle type 1 diabetes include solid- -organ pancreas and islet transplantation. Beta cell replacement therapy may be offered to patients with both good kidney function and renal failure. In progressive renal failure, beta cell transplantation may be performed simultaneously with kidney transplantation or afterwards. Islet autotransplantation is offered to patients submitted to total pancreatectomy. In patients with brittle type 1 diabetes who continue to experience life threatening severe hypoglycaemia episodes despite optimized insulin therapy, beta cell replacement helps improve hypoglycaemia awareness, thus reducing the risk of severe hypoglycaemia episodes, facilitates blood glucose control with normalization of haemoglobin A1c (HbA1c) level, and reduces microvascular disease progression. In patients undergoing total pancreatectomy, infusion of the patient’s own islets isolated from the removed pancreas prevents blood glucose level excursions and reduces the risk of surgically- -induced diabetes. In this article, we review the current indications and contraindications to beta cell replacement, expected benefits, and possible complications of beta cell transplantation.

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Keywords

solid-organ pancreas transplantation, pancreatic islet transplantation, severe hypoglycaemia, diabetes type 1, total

About this article
Title

Beta cell replacement therapy

Journal

Clinical Diabetology

Issue

Vol 9, No 5 (2020)

Article type

Review paper

Pages

344-355

Published online

2020-09-17

DOI

10.5603/DK.2020.0035

Bibliographic record

Clinical Diabetology 2020;9(5):344-355.

Keywords

solid-organ pancreas transplantation
pancreatic islet transplantation
severe hypoglycaemia
diabetes type 1
total

Authors

Justyna Gołębiewska
Bogumił Wolnik
Michał Hoffmann
Piotr Witkowski
Tomasz Stefaniak
Alicja Dębska-Ślizień

References (22)
  1. Gruessner AC, Gruessner RWG. Pancreas Transplantation of US and Non-US Cases from 2005 to 2014 as Reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR). Rev Diabet Stud. 2016; 13(1): 35–58.
  2. www.poltransplant.org.pl.
  3. The CITR Coordinating Center and Investigators. 10th Collaborative Islet Transplant Registry 2017 Annual Report.
  4. Sucher R, Rademacher S, Jahn N, et al. Effects of simultaneous pancreas-kidney transplantation and kidney transplantation alone on the outcome of peripheral vascular diseases. BMC Nephrol. 2019; 20(1): 453.
  5. Voglová B, Hladíková Z, Nemétová L, et al. Early worsening of diabetic retinopathy after simultaneous pancreas and kidney transplantation-Myth or reality? Am J Transplant. 2020 [Epub ahead of print].
  6. Argente-Pla M, Pérez-Lázaro A, Martinez-Millana A, et al. Simultaneous pancreas kidney transplantation improves cardiovascular autonomic neuropathy with improved valsalva ratio as the most precocious test. J Diabetes Res. 2020: 7574628.
  7. Lindahl JP, Hartmann A, Aakhus S, et al. Long-term cardiovascular outcomes in type 1 diabetic patients after simultaneous pancreas and kidney transplantation compared with living donor kidney transplantation. Diabetologia. 2016; 59(4): 844–852.
  8. Thompson DM, Meloche M, Ao Z, et al. Reduced progression of diabetic microvascular complications with islet cell transplantation compared with intensive medical therapy. Transplantation. 2011; 91(3): 373–378.
  9. Fensom B, Harris C, Thompson SE, et al. Islet cell transplantation improves nerve conduction velocity in type 1 diabetes compared with intensive medical therapy over six years. Diabetes Res Clin Pract. 2016; 122: 101–105.
  10. Vantyghem MC, Chetboun M, Gmyr V, et al. Members of the Spanish Back Pain Research Network Task Force for the Improvement of Inter-Disciplinary Management of Spinal Metastasis. Ten-Year Outcome of Islet Alone or Islet After Kidney Transplantation in Type 1 Diabetes: A Prospective Parallel-Arm Cohort Study. Diabetes Care. 2019; 42(11): 2042–2049.
  11. Rickels MR, Stock PG, de Koning EJP, et al. Defining outcomes for β-cell replacement therapy in the treatment of diabetes: a consensus report on the igls criteria from the IPITA/EPITA opinion leaders workshop. Transplantation. 2018; 102(9): 1479–1486.
  12. Meier JJ, Hong-McAtee I, Galasso R, et al. Intrahepatic transplanted islets in humans secrete insulin in a coordinate pulsatile manner directly into the liver. Diabetes. 2006; 55(8): 2324–2332.
  13. Pepper AR, Gala-Lopez B, Ziff O, et al. Revascularization of transplanted pancreatic islets and role of the transplantation site. Clin Dev Immunol. 2013; 2013: 352315.
  14. von Zur-Mühlen B, Lundgren T, Bayman L, et al. Open Randomized Multicenter Study to Evaluate Safety and Efficacy of Low Molecular Weight Sulfated Dextran in Islet Transplantation. Transplantation. 2019; 103(3): 630–637.
  15. Lindahl JP, Hartmann A, Horneland R, et al. Improved patient survival with simultaneous pancreas and kidney transplantation in recipients with diabetic end-stage renal disease. Diabetologia. 2013; 56(6): 1364–1371.
  16. Esmeijer K, Hoogeveen EK, van den Boog PJM, et al. Dutch Transplant Centers, Dutch Kidney Transplant Centres. Superior Long-term Survival for Simultaneous Pancreas-Kidney Transplantation as Renal Replacement Therapy: 30-Year Follow-up of a Nationwide Cohort. Diabetes Care. 2020; 43(2): 321–328.
  17. Wojtusciszyn A, Branchereau J, Esposito L, et al. TREPID group. Indications for islet or pancreatic transplantation: Statement of the TREPID working group on behalf of the Société francophone du diabète (SFD), Société francaise d'endocrinologie (SFE), Société francophone de transplantation (SFT) and Société française de néphrologie - dialyse - transplantation (SFNDT). Diabetes Metab. 2019; 45(3): 224–237.
  18. Lablanche S, Borot S, Wojtusciszyn A, et al. GRAGIL Network. Five-Year Metabolic, Functional, and Safety Results of Patients With Type 1 Diabetes Transplanted With Allogenic Islets Within the Swiss-French GRAGIL Network. Diabetes Care. 2015; 38(9): 1714–1722.
  19. Shapiro A, Ricordi C, Hering B, et al. International trial of the edmonton protocol for islet transplantation. N Engl J Med. 2006; 355(13): 1318–1330.
  20. Tatum JA, Meneveau MO, Brayman KL. Single-donor islet transplantation in type 1 diabetes: patient selection and special considerations. Diabetes Metab Syndr Obes. 2017; 10: 73–78.
  21. Renaud F, Chetboun M, Thevenet J, et al. Safety of islet autotransplantation after pancreatectomy for adenocarcinoma. Transplantation. 2019; 103(1): 177–181.
  22. Balzano G, Maffi P, Nano R, et al. Autologous islet transplantation in patients requiring pancreatectomy: a broader spectrum of indications beyond chronic pancreatitis. Am J Transplant. 2016; 16(6): 1812–1826.

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