Islet Transplantation (Continued)
Researchers use specialized enzymes to remove islets from the pancreas of a deceased donor. Because the islets are fragile, transplantation occurs soon after they are removed. Typically a patient receives at least 10,000 islet "equivalents" per kilogram of body weight, extracted from two donor pancreases. Patients often require two transplants to achieve insulin independence. Some transplants have used fewer islet equivalents taken from a single donated pancreas.
Transplants are often performed by a radiologist, who uses x rays and ultrasound to guide placement of a catheter—a small plastic tube—through the upper abdomen and into the portal vein of the liver. The islets are then infused slowly through the catheter into the liver. The patient receives a local anesthetic and a sedative. In some cases, a surgeon may perform the transplant through a small incision, using general anesthesia.
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.
What are the benefits and risks of islet transplantation?
The goal of islet transplantation is to infuse enough islets to control the blood glucose level without insulin injections. Other benefits may include improved glucose control and prevention of potentially dangerous episodes of hypoglycemia. Because good control of blood glucose can slow or prevent the progression of complications associated with diabetes, such as heart disease, kidney disease, and nerve or eye damage, a successful transplant may reduce the risk of these complications.
Risks of islet transplantation include the risks associated with the transplant procedure—particularly bleeding and blood clots—and side effects from the immunosuppressive drugs that transplant recipients must take to stop the immune system from rejecting the transplanted islets.
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There are very few conditions under which I will not ride my (road) bike. More than an inch of new snow, snow pack, and slush are the three major ones. That said, if the distance is short and familiar, and traffic is expected to be light, I'll take my chances. I was considerably less hesitant in my teens and twenties when I had two bicycles in my stable: a three-speed commuter and a 12-speed touring bike. My craziest experiences then were riding through what I later...