Islet Cell Transplantation

Islet Cell Transplant

Islet cell transplantation is a treatment option for adults with type 1 diabetes who struggle to control their blood sugar levels due to frequent episodes of severe low blood sugar and hypoglycemia unawareness, a condition where patients cannot detect when their blood sugar is dropping, despite intensive diabetes management and education.

After islet cell transplantation, patients may not need insulin injections for months, years, or ever again. However, additional islet cell transplant infusions may be considered depending on how the patient responds to the first treatment.

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How does the islet cell transplant process work?

All potential islet cell transplant patients must undergo a pre-transplant evaluation process to make sure they are medically appropriate for the procedure. Once it is determined that the patient qualifies for islet cell transplantation, the transplant team will add the patient to the UNOS islet cell transplant waiting list.

When a deceased donor pancreas becomes available, the islet cells from the donor pancreas are isolated and purified. They are then administered through a catheter into the patient’s liver.

The patient will stay in the hospital overnight and be discharged home the next day. After the transplant, the patient will require immunosuppression therapy to prevent rejection of the transplanted islet cells.

What makes someone eligible for islet cell transplantation?

To be considered eligible for islet cell transplantation, patients need to meet the requirements in our eligibility criteria below:

• Over age 18 years
• Have Type 1 diabetes for more than five years
• HbA1C level greater than 6.5
• Insulin dependence
• Body Mass Index (BMI) lower than 27
• Adequate support from family or friends to help with post-surgery care
• Ability to provide long-term financial coverage for transplant and post-transplant medication management
• No other immediate diseases or health problems of the heart, lungs, liver, kidney, or brain
• No active infections
• Patients must have experienced at least one or more of the following despite trying to manage their diabetes with insulin:
  • One or more severe episodes of low blood sugar in the past three years
    • Blood sugar less than 50 mg/dL
    • Symptoms of low blood sugar
    • Needing someone else’s help to treat low blood sugar (injection of glucagon, bringing you food or juice, EMS/911)
    • Hypoglycemia unawareness: Not being able to tell when your blood sugar is low, even if it drops below 54 mg/dL

What are the risks?

Pancreatic islet cell transplantation involves some risks. The infusion procedure and the use of immunosuppression (or anti-rejection) medications to prevent the body from rejecting the donor cells can cause side effects such as:

• Nausea, fatigue, or diarrhea
• Abdominal pain
• Anemia (low red blood cell count)

Serious side effects from islet cell transplantation are rare but may occur, including complications from the infusion procedure or reactions to the medications needed to prevent rejection of the cells. In some cases, this can lead to the loss of islet cell function, meaning patients may need to resume insulin injections.

What are alternatives?

Patients who are not eligible for islet cell transplantation might be referred to the UI Health Transplantation Program for a pancreas alone or combined kidney/pancreas transplant.

Will insurance cover the procedure?

The UI Health transplant financial team will work with patients and insurance companies on coverage options.

For More Information

If you or a loved one has type 1 diabetes and struggles with severe hypoglycemia, talk to your healthcare provider about whether pancreatic islet cell transplantation is right for you.

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