"This is a giant step for diabetes research, our transplant team, our patient, and all Type 1 diabetics," said Dr. Gores. "I can't tell you how exciting it is to be a part of ground-breaking research that could one day change the quality of millions of lives."
Dr. Gores stresses that this procedure, while successful in this case, and an important step in the research that will eventually result in a cure for all insulin-dependent diabetics, is not a cure for everyone. Only a few medical centers in the world - ten in the United States - are currently offering this procedure, which is experimental and done as clinical research.
"A significant challenge remains the scarcity of organ donors," explained Dr. Gores. Also because patients must take immunosuppressive drugs to protect the transplanted tissue from being rejected, the procedure is only for a select group of patients with Type I diabetes. Immunosuppressive drugs have several potentially serious side effects and until a method is discovered that protects the islets and is free of dangerous side effects, the procedure will not be appropriate for the vast majority of diabetic patients.
Islets are cell clusters in the pancreas that determine the body's need, and release the necessary amount of insulin to maintain normal blood sugar levels in the body. In Type 1 diabetes, the pancreas does not produce that insulin, forcing patients to inject insulin every day. Type 1 diabetes carries with it increased risks of kidney failure, nerve damage, heart disease, and blindness.
"Daily insulin shots have been a part of my life for years," relates patient Andrea "Annie" Anderson. "I'm still getting used to life without finger pricks and needle sticks. I feel so fortunate to have received this procedure and for it to have been successful."
Before the transplant, islet cells are collected from a donor pancreas through a complex purification process. Physicians then insert a catheter into the patient's abdomen, and using x-ray guidance, thread it into the portal vein, which carries blood to the liver. About a teaspoonful of islet cells are injected through the catheter. The cells disperse throughout the liver where it is intended that they will live and produce insulin. The patient is alert during the process but receives local anesthesia to numb the skin where the catheter is inserted. Most patients stay in the recovery area for a few hours, and are able to go home within a day or two. As in Annie's case, more than one transfusion of islet cells may be needed.
"Islet transplantation has been in the experimental stage for more than 25 years," said Dr. Gores. "It's considered a treatment rather than a cure, although in several recent studies, islet cell transplantation has been successful enough for some people with Type 1 diabetes to completely stop taking insulin injections. For Anderson this is a dream come true."
CMC's islet cell transplant research is being funded by the National Institutes of Health.
The Transplant Center at Carolinas Medical Center in Charlotte has been active in transplantation since 1970 when the first kidney transplant was performed here. The program has grown steadily and today includes programs transplanting heart, liver, kidney and pancreas.
The islet transplant teams consist of surgeons, nephrologists (physicians specializing in kidney disease), transplant coordinators, scientists, social workers, dietitians and pharmacists. In 2004, the Transplant Center performed 83 kidney, 17 heart, 24 liver, and 5 kidney/pancreas transplants.
Carolinas Medical Center is an Academic Medical Center Teaching Hospital and Level I Trauma Center. It is part of Carolinas HealthCare System, a not-for-profit, self-supporting public organization. Carolinas HealthCare System is the largest healthcare system in the Carolinas, and one of the largest public systems in the nation. CHS owns, leases and manages hospitals, nursing homes, physician practices, home health agencies, radiation therapy facilities, physical therapy facilities, and other healthcare related operations, comprising more than 4,300 licensed beds and approximately 25,300 employees.