Pancreatic Islet Transplantation in Type 1 Diabetes Mellitus Results of Australia's First Trial
An Australian trial involving six diabetic patients has found that transplanting pancreatic islets can control diabetes and prevent severe life-threatening hypoglycaemia (a deficiency of glucose in the bloodstream) over the short term. The islets of Langerhans are small groups of cells in the pancreas that secrete the hormones insulin and glucagon.
Conducted by the National Pancreas Transplant Unit and the Department of Endocrinology at Westmead Hospital, Sydney, the trial examined transplants on six patients who had suffered type 1 diabetes mellitus for more than five years. The transplants were performed at Westmead Hospital between October 2002 and February 2005. Islets from donor pancreases were infused into the liver of each patient.
The Director of Transplantation, Dr Philip O'Connell, said his team was looking for normal blood glucose control without insulin, demonstration of transplanted islet function, and abolition of hypoglycaemia as measures of success in the patients.
One patient developed a thrombosis and was withdrawn early from the trial. All five remaining patients had evidence of islet function after the first graft, and three of them were able to stop insulin treatment completely for a period of time. One of the three withdrew after 7.5 months because of intolerance to the medication.
The remaining two patients had evidence of substantial islet function and major reductions in insulin dose. All recipients with evidence of islet function showed marked improvements in blood glucose control. However, over a two-year period, graft function deteriorated and some complications set in.
There were problems with long-term safety of immunosuppressive drugs, thrombosis, and early detection of loss of islet function.
Nevertheless, the study team was encouraged by the outcomes, with the trial considered a starting point for more detailed research - but these early results will give hope to sufferers of diabetes.
"The critical question of whether islet transplantation can effectively reduce secondary complications cannot be evaluated until better long-term engraftment is achieved. This goal remains the primary focus of our research," say the authors.
The Medical Journal of Australia is a publication of the Australian Medical Association.