Authors' objectives:

This review aims to assess the available evidence on the effectiveness of pancreatic islet transplantation for patients with type 1 diabetes mellitus.

Authors' recommendations: With respect to pancreatic islet transplantation for patients with type 1 diabetes mellitus, the ICSI Technology Assessment Committee finds: Pancreatic islet transplantation appears to be safe with low mortality and acceptably low morbidity. Although the number of patients treated is small, recent reports suggest that the efficacy of islet transplantation with respect to insulin independence, glycemic control, and serum C-peptide levels has improved dramatically in the past 2 years at certain centers. Islet allograft survival has increased from 35% to 60% or higher (values more similar to those observed following pancreas transplant). The improvement is attributed to changes in procedures for processing the islets, the number of islets transplanted, and the immunosupressive regimens. The reproducibility of these findings (i.e., effectiveness) is currently being tested in multicenter studies around the world. (Conclusion Grade III) To date, the longest reported post-transplantation follow-up period in a published study is 20 months; 24 month follow-up was presented in an abstract. The population of patients most appropriate for transplantation remains to be determined. Due to the apparent low morbidity associated with islet transplantation, the risk/benefit analysis may include patients with less severe complications than those awaiting pancreas transplantation. At present, due to difficulties with harvesting adequate numbers of islet cells and the need for evidence of the reproducibility (effectiveness) of the procedure, islet transplantation is not a viable treatment option for most patients with type 1 diabetes mellitus. No randomized trials have been completed or proposed.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.icsi.org/index.asp

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Institute for Clinical Systems Improvement

Contact Address: 8009 34th Avenue South, Suite 1200, Bloomington, MN, USA. Tel: +1 952 814 7060; Fax: +1 952 858 9675

Contact Name: icsi.info@icsi.org

Contact Email: icsi.info@icsi.org

Copyright: Institute for Clinical Systems Improvement (ICSI)