Donor and recipient selection for islet transplantation

Today there are approximately 130 million people with diabetes, and the incidence is rising among all age groups. Insulin treatment can maintain the functionality necessary to keep these patients alive, but it cannot prevent the evolution of the disease. Clinical islet transplantation offers the promise of curing in type I diabetes mellitus by an injection of cellular grafts into the liver, freeing the patient from daily insulin injections and preventing potential secondary complications. In a recent Canadian experience, a series of patients receiving islet grafts in conjunction with a steroid-free immunosuppression achieved sustained insulin independence. Donor selection is at the present time based on whole pancreas transplantation donor criteria, but experimental findings on age, pancreatic tissue fibrosis and non-heart-beating donors clearly demonstrate the bright prospects for the expansion of islet donor sources. Research in the islet transplantation field is currently concentrating on reversing diabetes in nonuremic type I patients. Strict recipient inclusion criteria have been proposed by the experienced Canadian group and the Immune Tolerance Network islet trial. At this stage, determination of major guidelines is the most important condition to reproduce the recently reported successful results, and more consistently demonstrate the feasibility of this minimally invasive procedure for the treatment of diabetes.