JDRF Research
First Live-Donor Islet Transplant Performed in Japan
The first-ever transplant using islets (clusters of insulin-producing beta cells) from the pancreas of a live human donor was performed in Japan in January. This variation of islet transplantation could potentially make the procedure available to a much larger group of patients with type 1 diabetes. However, the method is still experimental and is not expected to be available to patients in the U.S. or Canada in the near future.
JDRF researcher James Shapiro, M.D., Ph.D., of the University of Alberta, Canada, in collaboration with a research team from Kyoto University Hospital in Japan, supervised a team that transplanted islets isolated from a portion of a pancreas removed from a 56-year-old woman into the woman’s 27-year-old daughter, who had type 1 diabetes and met criteria for islet transplantation.
Both the donor and the recipient are reported to be in good health after the procedure and completely “insulin independent”at this time. The daughter received immune-suppressing drugs to prevent the islets from being rejected—part of a transplant protocol developed by Dr. Shapiro—and she will need to continue taking the drugs indefinitely. The live-donor transplant was not part of a JDRF-funded research program.
Dr. Shapiro, who is director of the JDRF Clinical Center for Islet Transplantation at the University of Alberta, said Japan was a good site in which to try a living-donor procedure because, for cultural reasons, few transplants are performed there using organs or tissue taken from cadavers. At present, no hospital in North America has approved such a procedure, although Dr. Shapiro noted that plans are under way to explore the possibility at his institution in Edmonton.
Before the transplant, the islet recipient had been experiencing hypoglycemic unawareness as a result of severe diabetes. The donor was of normal body size and was “islet antibody negative,” meaning that she did not have evidence of beta cell autoimmunity that would either put her at risk of developing type 1 diabetes or provide less optimal islets for transplantation.
Dr. Shapiro said the amount of islets yielded by the live donor was higher than is usually isolated from cadavers. He also thinks the islets are healthier than those obtained from cadavers, although further investigation is needed to confirm this. One of the problems with using cadaver islets for transplantation, aside from the lack of donor pancreases, is that islets from cadavers sometimes don’t function at the highest levels. Sometimes the viability of the organ can be compromised depending on why the donor died.
If living-donor transplantation eventually proves to be safe, it could significantly increase the number of patients who could benefit from an islet transplant. Such procedures could be scheduled in advance rather than depending on when a pancreas becomes available from a cadaver. But hospital institutional review boards will undoubtedly be cautious about giving approval for such procedures because of the risks they carry for donors – both from the surgical procedure itself, as well as for pancreatic function over the course of their lives.
“I am excited about the potential of living donor islet transplantation,” Dr. Shapiro said. “If it turns out that the transplants work even better than those growing from a cadaveric source, this could one day help to meet the growing gap between supply and need for islet transplantation in diabetes.
“However, as in all living donor surgery, the donor’s safety is paramount, and without stringent criteria in place for careful screening of potential donors, there is a small risk that a donor could be rendered diabetic in the process—which would be a catastrophic outcome. We are now moving forward to explore the possibilities of carrying out similar living donor islet transplants in Edmonton, although we anticipate this may take some time to put fully in place.”
Dr. Shapiro pioneered use of the Edmonton Protocol, a new experimental method for islet transplantation that represents true breakthrough in the treatment of type 1 diabetes, enabling transplanted patients to lower their rate of hypoglycemic episodes and maintain normal blood sugar levels without any (or with fewer) insulin injections. Since 2000, the Protocol has dramatically increased the success rate for the islet transplantation procedure.