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Pancreatic islet cell transplantation: procedure, prognosis
Medical expert of the article
Last reviewed: 07.07.2025
Pancreatic islet transplantation has theoretical advantages over whole-organ transplantation: the procedure is less invasive, and the islets can be cryopreserved, allowing for optimization of transplantation time. However, the procedure is too new to provide any advantages, but continuous improvements in the technique increase the chances of success. Disadvantages include that the transplanted glucagon-secreting alpha cells are nonfunctional (possibly leading to hypoglycemia) and that multiple pancreases are required to obtain islets for a single patient (which exacerbates the supply-demand imbalance and the limitation of the procedure). However, islet transplantation has been shown to help maintain normal blood sugar levels in patients requiring total pancreatectomy due to pain from chronic pancreatitis. Indications for surgery are the same as for whole-pancreas transplantation. Simultaneous islet and kidney transplantation may become a viable operation once technology improves.
Pancreatic Islet Cell Transplant Procedure
The pancreas is removed from brain-dead cadaveric donors; collagenase is perfused through the pancreatic duct to separate the pancreatic islets from the pancreatic tissue. The purified islet cell fraction is injected percutaneously into the portal vein. The islet cells migrate to the hepatic sinuses where they settle and secrete insulin.
Outcomes are better when 2 or 3 infusions of islets from 2 deceased donors are given, followed by immunosuppressive therapy including anti-IL-2 receptor antibodies, monoclonal antibodies (daclizumab), tacrolimus, sirolimus; glucocorticoids are not used. Immunosuppressive therapy should be continued for life or until islet cells stop functioning. Rejection is difficult to detect but can be diagnosed by abnormal blood glucose levels; there is no established treatment for rejection. Complications of the procedure include bleeding during percutaneous liver puncture, portal vein thrombosis, and portal hypertension.
Successful islet transplantation maintains short-term normoglycemia, but long-term outcomes are unknown; long-term insulin independence requires additional islet cell administration.
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