Islet Transplant
The Scottish Islet Transplant Unit is a service based at the Edinburgh Transplant Centre in the Royal Infirmary of Edinburgh. Since it was launched in 2009, the service has performed over 90 islet cell transplantations.
Islet Cell Transplantation
Islet cell transplantation is procedure for patients with type 1 diabetes who have poor blood glucose awareness and frequently experience severe hypoglycaemic events. The aims of the procedure include reducing the frequency of severe hypoglycaemia, improve blood glucose awareness, and improve the quality of life for patients.
Islet cell transplantation can be performed alone or performed as part of a simultaneous islet kidney (SIK) transplant.
The Scottish National Islet Cell Transplant Programme launched in 2009 and has since performed over 100 islet cell transplants.
The aim of the progamme is to treat individuals with with type 1 diabetes who have lost the ability to recognise when their blood sugar levels are low and experience severe hypoglycaemic events.
Islet Transplant Management Protocol
The following protocol has been prepared by staff of the Scottish Islet Transplant Unit for internal use:
Simultaneous Islet Kidney Transplantation Protocol
The following protocol has been prepared by staff of the Scottish Islet Transplant Unit and the East of Scotland Renal Transplant Unit for internal use:
The following leaflets and booklets contain information about islet transplantation. They may help answer questions you may have about the procedure.
Your Islet Transplant
Islet cell transplantation is a procedure involving the injection of islet cells removed from a deceased donor pancreas into your liver. This can improve glucose control and restore awareness of hypoglycaemia. Most people require two islet transplantations.
Click on the titles below to find out more about islet cell transplantation.
An islet cell transplant involves injecting islet cells taken from a deceased donor into a vein within the liver (the portal vein) of a patient.
Islet cells (or Islets of Langerhans) are groups of cells found within the pancreas. Some islet cells known as ‘beta cells’ produce insulin. These cells produce insulin when blood sugar levels in the body are high. Insulin brings the blood sugar levels down again. When blood sugar levels are low, islet cells stop producing insulin.
Islet cells as seen through a microscope
An islet cell transplant aims to reduce the frequency of severe hypoglycaemia, improve awareness of hypoglycaemia, improve quality of life, reduce fear of hypoglycaemia, and reduce the risk of long-term complications of diabetes.
Types of Islet Transplant
There are different types of islet transplant and these will be discussed when you meet with the transplant team.
- Islet Transplantation is the injection of islet cells into your liver.
- Simultaneous Islet Kidney (SIK) transplant means you will receive islet cells removed from the pancreas of the same donor that you receive the kidney from. This is suitable for patients who were considered for simultaneous pancreas kidney transplant but the risks of surgery was considered too great.
Islet cell transplantation may be appropriate for patients with type 1 diabetes with severe hypoglycaemia, poor glucose control, and have good kidney function.
Some people with type 1 diabates find it difficult to manage their blood sugar despite the great efforts they make with their diet, their lifestyle, and take multiple insulin injections or use an insulin pump. Their blood sugar varies greatly, going from high to low levels unpredictably. They have frequent episodes of severe hypoglycaemia which mean they need help from other people and often have no symptoms or warning when their blood glucose is low (impaired awareness of hypoglycaemia). This can be very dangerous, and can have adverse effects on their quality of life and the lives of their families.
An islet transplant aims to reduce the frequency of severe hypoglycaemia and improve awareness of hypoglycaemia. Ultimately, this will improve quality of life, reduce fear of hypoglycaemia, and reduce the rick of long-term complications of diabetes.
Who may not be suitable for an islet transplant?
Some people may not be suitable for an islet transplant. This may be due to:
- having moderate or severe kidney malfunction. Anti-rejection medication can worsen kidney function, and your medical team will assess this pre-transplant.
- being very insulin-resistant.
- taking more than 60 units of insulin per day.
- women and men planning pregnancy, because we are not certain of the long term effects of some anti-rejection drugs on the unborn baby.
- other less common reasons which your medical team will discuss with you.
Rejection of the Transplanted Islet Cells
Rejection may occur which means your new islets stop producing insulin. Whilst this can occur anytime after your procedure, complete failure of the islets is uncommon. It is expected that seven out of 10 people will continue to have clinical benefit from their transplant after five years. This is in terms of fewer severe hypoglycaemic episodes, better control of their diabetes, and better quality of life.Side-effects of the Anti-rejection Medication
The anti-rejection drugs you are given may cause side-effects. Side-effects include worsening your kidney function, mouth ulcers, nausea, diarrhoea, constipation, acne, joint aches, hand shaking, and ankle swelling. The anti-rejection medication increases the risk of infection. This is because the medication dampens your immune system so as not to reject the transplanted islet cells. Most infections can be treated and the risk of dying due to infection is probably less than two people in every 100 treated over six years with immunosuppressant medication. The anti-rejection medication also increases the risk of cancers for similar reasons as above. Most of these cancers are likely to be treatable, but sadly some of these will be fatal. However, as you will be monitored closely after your transplant, most cancers (if they develop) will be detected at an early and potentially treatable stage. Also, approximately eight out of every 100 islet cell transplant patients is likely to develop skin cancer. Almost all of these cancers will be treatable and are unlikely to be fatal. The risk of skin cancer can be reduced by having regular skin examinations, by using the highest factor sun-block, and covering up in the sun. You will be encouraged to examine your skin on a monthly basis and let your medical team know about any changes, or unusual lumps and bumps.Other Risks
Other risks associated with islet cell transplanted are summarised in the table below.| Risk | Occurrence |
|---|---|
| Death due to the operation or procedure | Less than 1 patient in 100 |
| Operation to open the tummy | 2 patients in 100 |
| Repeat operation on the tummy | Close to zero |
| Serious surgical complications including colostomy | Close to zero |
| Any infection over 6 years | 17 patients in 100 |
| Life-threatening infection with long-term clinical effects over 6 years | 2 patients in 100 |
| Death due to infection over 6 years | 1 patient in 300 |
| Cancer, potentially life-threatening, over 6 years (except skin cancer) | Less than 2 patients in 100 |
| Skin cancer including melanoma (often treatable) over six years | 8 patients in 100 |
| Severe reduction in kidney function due to anti-rejection medication | Sometimes |
The goals of islet cell transplantation are:
- Reduce the frequency of severe hypoglycaemia
- Improve awareness of hypoglycaemia
- Improve quality of life
- Reduce fear of hypoglycaemia
- Reduce the risk of long-term complications of diabetes
The goal of treatment is NOT to eliminate the need for insulin injections. However, this can be a great bonus when this happens. For some people, they will have freedom from insulin injections for up to one year and very occasionally for more than five years. For others, they will need to continue with some level of injected insulin from the start.
Contacting the Scottish Islet Transplant Unit
We are experiencing a high volume of calls due to the current Coronavirus pandemic. There is a voicemail service available for you to leave a message. A member of staff will get back to you to address your concerns.
If you would like to speak to someone, please use the telephone numbers below. Other contact details can be found on the Contact Us page.
Scottish Islet Coordinators
Kirsty Duncan: 0131 242 1730
