Islet transplantation: Present and future perspectives

Islet cell transplantation can potentially normalize blood glucose levels a nd stop the progression of clinical complications, and if the transplant is done early in the course of the disease complications may be prevented. Re markable progress has been made in recent years and islet cell transplantat ion has resulted in normalization of metabolic control in several patients with Type 1 diabetes in the absence of hypoglycemia. Only a few patients, h owever, have achieved insulin independence. Issues relating to islet cell e ngraftment within the liver, prevention of rejection and recurrent autoimmu nity, and identification of alternative immunosuppressive drugs that do not adversely affect islet cell function remain to be solved. Thus far, the ne ed for chronic, generalized immunosuppression to prevent rejection of the i slets has Limited the indication to those patients who have already receive d another transplant or to those who simultaneously receive islets and anot her organ (generally a kidney). Identification of immunointervention protoc ols that allow for engraftment in the absence of deleterious effects on the islets and prevent rejection and recurrent autoimmunity would make this pr ocedure suitable for all patients, including children who have not yet deve loped long-term complications of the disease. Copyright (C) 1998 John Wiley & Sons, Ltd.