A rising demand for islet transplantation will lead to severe donor shortage in the near future, especially in countries where cadaveric organ donation is scarce.
Since the success of islet transplantation in 2000 from the organs of dead donors, demand for the procedure has risen substantially and donors will soon be in very short supply.
Islet transplantation from living donors represent an alternative approach to expand the potential donor pool, particularly in countries like Japan where the number of people donating their organs after death is low.
2 previous attempts at transplantation from living donors have been carried out in the US but were unsuccessful.
Dr Shinichi Matsumoto and colleagues from Japan undertook a successful transplantation of living-donor islets for unstable diabetes.
The donor was a 56 year old woman who was also the mother of the recipient.
The researchers reported that the donor had a compatible blood group and also had healthy glucose and insulin concentrations.
The research team informed that the recipient was a 27 year old woman who had developed insulin-dependent diabetes when she was 15 years old.
|The patient became insulin-independent 22 days after the transplantation|
The investigators noted that the recipient had been admitted to hospital to control her frequent hypoglycaemic episodes, when her blood sugar levels dropped below normal.
The recipient received insulin injections every day in hospital.
The investigative team isolated islet cells from the donor and transplanted them into the recipient’s liver at Kyoto University Hospital in January 2005.
The researchers monitored the patient’s blood glucose after the operation and gradually weaned her off the insulin.
The investigators reported that the patient became insulin-independent 22 days after the transplantation and has been insulin independent for 2 months
The donor had no complications and both women have a healthy tolerance to glucose.
The investigators state that islets from living donors are more viable and more likely to function properly compared to islets from organs of dead donors.
The researchers derived the transplant cells from half of a living pancreas and reported a similar effect to that achieved from cells of 2 or more whole pancreases from dead donors.
The research team suggests that the difference in organ requirements indicate that improved potency of islets from living donors.
Dr Matsumoto concludes "From our successful transplantation of living-donor islets for treating unstable diabetes, our recipient achieved and maintained insulin dependence after procedure."
“Transplantation of living-donor islets from the distal pancreas can be sufficient to reverse brittle diabetes and be an additional option for the treatment thereof.”
In an accompanying comment, Dr Stephanie Amiel from the UK, states that, "In Japan, cultural considerations restrict the use of cadaveric donors."
"For patients with crippling hypoglyceamia in such societies, the only realistic donor would be a living donor."
"Islet transplant is not yet a perfect technique and insulin is only likely in the very insluin sensitive."