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Diabetes International Foundation - Pancreatic Islet Transplantation Info What are pancreatic islets? The pancreas, an organ about the size of a hand, is located behind the lower part of thestomach.
Islets are made up of several types of cells, including beta cells that make insulin. The pancreas is located in the abdomen behind the stomach. Islets within the pancreas contain beta cells, which produce insulin. Insulin is a hormone that helps the body use glucose for energy. Diabetes develops when the body doesn't make enough insulin, cannot use insulin properly, or both, causing glucose to build up in the blood. In type 1 diabetes-an autoimmune disease-the beta cells of the pancreas no longer make insulin because the body's immune system has attacked and destroyed them.
Type 2 diabetes usually begins with a condition called insulin resistance, in which the body has difficulty using insulin effectively. Over time, insulin production declines as well, so many people with type 2 diabetes eventually need to take insulin. What is an islet cell transplant?An islet cell transplant is a treatment for people with type 1 diabetes who have trouble controlling their glucose (blood sugar).
There is a limited supply of islet transplants available, so transplant centers are careful to select only those patients who really need the procedure and will be most likely to benefit.
Islet transplants are done alone or after a kidney transplant (islet alone, or islet after kidney).
This means that it has not been proven to be the best way to treat type 1 diabetes. How does a person get an islet cell transplant?Most centers require patients to enter a clinical trial, also called a study. A clinical trial is a research study where doctors try experimental drugs or medical treatments to learn more about diseases and their cures.
During your clinical trial, transplant doctors will watch how your body reacts to different tests and treatments. You have to visit the clinic a lot and have extra blood work done. When you sign up for the clinical trial, you will be given an application package. The tests and exams are different at each center. Blood testsThe blood tests are done on the first day of your assessment. The total amount of blood that is taken is less than the amount given during a regular blood donation. After you are done, you will go back home and wait while the doctors look at your test results. Once all tests are done, the islet transplant team will look at the results and decide what to do next. In 3 or 4 days, the transplant coordinator will let you know your test results and what will happen next. What happens if I am a good match for a clinical trial?If you are a good match for a study, you will meet the doctors who are running that study.
After you sign the consent form you will meet with a coordinator to go over the plan for your transplant. When you get the call, you will need to go to the hospital quickly (within a few hours at most).
Keep this list with you at all times.Make sure you know ahead of time what you need to pay for and have the money with you. If you have any questions about this, talk to your transplant nurse coordinator or the social worker at the program.Have a bag packed and ready to go. You will need to monitor your blood sugar regularly, even while in the hospital. Being on the list does not mean you will get an islet transplant. Know which friends and family members can help at any time. If your health changes, see your regular doctor soon. Your center might have a glucose meter with memory, which would allow them to download your readings and compare your glucose control before and after the islet transplant. THE TRANSPLANT PROCEDURE It is your responsibility to be ready when the center calls. This way, if the transplant is cancelled, you can be reached while you are on your way to the hospital. Even if the center calls you, you may not get the transplant.
This is because sometimes doctors cannot get enough cells from the pancreas to make the transplant work. The transplant might be cancelled at any step, and you will be sent home. Islets extracted from a donor pancreas are infused into the liver.
Once implanted, the beta cells in the islets begin to make and release insulin. Islets begin to release insulin soon after transplantation. However, full islet function and new blood vessel growth associated with the islets take time.
The doctor will order many tests to check blood glucose levels after the transplant, and insulin is usually given until the islets are fully functional. Where does the pancreas come from?The pancreas comes from the same deceased donors that give hearts, lungs, livers, and kidneys. These people tell their family and friends that they want to give their organs to someone else after they die.
By donating, these people are giving you a chance to have your islet transplant. Transplant centers need one, two, or sometimes three pancreas organs for every islet transplant patient. Because one transplant needs one whole pancreas, a friend or family member cannot donate a section of their pancreas.
This is different from a kidney transplant, where people can donate one kidney and still be healthy with the one they have left. What happens when I get to the hospital?When you arrive at the hospital, you will be registered and given a room.
Your nurse will ask some questions about your medical history, then start an intravenous line (IV) for your medicines. Your care team will draw blood, perform an EKG and take a chest x-ray. Islet cell transplant is done in the Radiology Department or in the Operating Room. You will also be asked to monitor your glucose and tell the nurse what your level is each time. In the Radiology Unit, you will get a local anesthetic. This is a drug that will be injected into the right side of your abdomen where the liver is located.
The radiologist will then place a needle and a tube into the main vein (portal vein) of the liver. Using a special x-ray machine (fluoroscopy) and dye, doctors will inject the solution containing the islet tissue.
Then they will remove the tube and take you back to the Nursing Unit where you will remain for several hours. If you do not take the anti-rejection drugs, your body will destroy the islet cells. You need to monitor your blood sugar levels very carefully. The transplant team will help you adjust the amount of insulin you need. Remember that the islet cells will take some time to settle into their new home in your liver.
We do not want to put stress on the islet cells, so it is important to keep your glucose at a good level. You do not want to make the new islets work too hard in the beginning. Taking care of your islet cells is like planting seeds in your garden. If you take good care of the cells right after your transplant, you have a better chance of good islet cell function.
You can do this by sticking to a healthy diet and taking your medications. What is rejection?Rejection is the body's natural defense against foreign cells or particles like bacteria and viruses.
Your immune system knows that your new islet cells are not part of your own body, so it may reject and destroy them. What can be done to keep my body from destroying my new islet cells? The doctors will use medicines that slow down your immune system enough to keep it from rejecting your islet cells. Some immunosuppressants are taken by mouth every day and others are given by vein less often. Because islet transplantation is experimental, it is not yet known what the best immunosuppressive drugs are to prevent rejection. The center will monitor your blood levels closely to make sure you do not reject your islet cells, or have too much of these drugs in your system.
Over time, you will need less monitoring. What can I do to prevent infections?You need to be careful about infections.
Here are some things you should do: Use sunscreen (SPF 15) to avoid burning or even tanning.
Not every center gives the same drugs, so ask your center to tell you which ones they prefer to use.
Before having your blood drawn, ask your center what time you should stop eating before blood tests and how you should take your medicines.As your islet cells begin to work and your drug levels stabilize, you will need fewer blood tests. After a while, you may be able to get your blood work done in a lab closer to your home. You will also have your lipids (fat levels) tested. You are more open to getting infections and cancer due to suppression of your immune system. This can make it harder for you to get another transplant because the immune system will respond much quicker the next time your immune system sees these antigens. This can affect the success rate of a kidney or other organ transplant. Weight gainBecause patients can eat a more normal diet after a successful islet transplant, some patients will gain weight. Researchers need to collect more safety data before these transplants are considered standard care in the United States. We also need to increase our supply of islet cells. We need to do more research so we can learn more about these medicines and develop medicines with fewer side effects.
What an islet cell transplant patient gets to do is exchange insulin shots for immunosuppressive drugs and glucose monitoring. Patients who used to have irregular glucose levels now take immunosuppressive drugs so they have stable glucose levels. This is a possible long-term treatment for people who suffer from type 1 diabetes. Can I buy an islet transplant?No. Patients cannot buy a transplant or pay to have their name put on a transplant list. Are there risks involved?Yes. As more patients are having transplants, more risks are being observed How much time does it take to be in a study?The first assessment takes about 10 days.
Some centers have patients who have combined kidney and islet transplants, either at the same time or one after the other. They can also be made ready at a later time, from a different donor, once the new kidney is stable. What does an islet cell transplant cost?The costs for a transplant are different at each center. The patient usually pays for transportation, housing, and medicines after leaving the hospital. If you need financial help, ask your transplant team if there are other programs that can help you pay for some of your costs. Sometimes the drug companies or clinical trial sponsors pay for the drugs, at least for a while.
Diabetes develops when the body doesn't make enough insulin, cannot use insulin properly, or both, causing glucose to build up in the blood. In type 1 diabetes-an autoimmune disease-the beta cells of the pancreas no longer make insulin because the body's immune system has attacked and destroyed them.
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