A New Home for Pancreatic Islet Transplants: The Bone Marrow

Transplantation of pancreatic islets represents a clinical therapeutic option to preserve and/or restore β-cell function in patients with diabetes (1,2). The source of the islets is the patient’s own pancreas (autologous, islet autotransplantation [IAT]) when the goal is preserving pancreatic endocrine function in pediatric and adult individuals undergoing total pancreatectomy due to pancreatitis (3,4) or trauma (5,6). Recently, IAT has been also proposed for enucleable benign (7) and malignant (8) pancreatic neoplasms. Transplantation of deceased-donor (allogeneic) islets is performed for patients with brittle type 1 diabetes and hypoglycemia unawareness as islet transplant alone (ITA) if nonuremic and as simultaneous islet–kidney (SIK) or sequential islet after kidney (IAK) transplantation procedures if uremic (end-stage renal disease) requiring kidney transplantation. Allogeneic islets can be part of cluster organ transplantation (Table 1). In recognition of the excellent metabolic control obtained after islet transplantation even when exogenous insulin treatment is required, reimbursement has been approved in several countries (e.g., Australia, Canada, France, Italy, Switzerland, U.K., Sweden, and the Nordic Network). In the U.S., only IAT is currently reimbursed, while biological licensure by the U.S. Food and Drug Administration should be imminent after recent completion of the Clinical Islet Transplant Consortium registration trials (www.citisletstudy.org). View this table: TABLE 1 Indications for islet cell transplantation Since the 1970s, islets have been embolized into the hepatic portal system by a minimally invasive technique consisting of transhepatic cannulation of the portal vein under ultrasound …