Islet cell transplant

Islet cell transplantation involves the administration of islet cells (present in the pancreas) in the liver so they can produce insulin hormone inside your body. 

The pancreatic islet cells consist of alpha and beta cells. The beta cells are responsible for the production of insulin hormone, which helps maintain blood sugar levels.

Sometimes, the immune system invades and destroys pancreatic beta cells, leading to type 1 diabetes. In this condition, your pancreas may produce very less insulin or stop producing insulin altogether. As a result, you may need to take injectable insulin every day to maintain your blood sugar levels.

Islet cell transplantation can be done in two ways:

Allotransplantation: In allotransplantation, islet cells will be transferred from a deceased (recently dead) donor into your liver. This method can reduce or eliminate the use of insulin injections. However, it requires the intake of immunosuppressants or anti-rejection medicines to prevent the rejection and destruction of the implanted cells by your body’s immune system. An allotransplant may not be offered due to a high rate of rejection.

Autotransplantation: Another way of receiving islet cells is called autotransplantation. In this procedure, your healthcare provider may transfer your own islet cells into your liver. This surgery will be performed after the removal of the pancreas (total pancreatectomy). You may not require any supplementary medications after an allotransplantation of islet cells as your body will recognise its own cells and does not reject them.

A healthcare provider may perform autotransplantation to reduce the risk of diabetes after removal of your pancreas.

Allotransplantation is performed to treat type 1 diabetes. However, not all individuals with type 1 diabetes can undergo this surgery. It is only conducted in people with diabetes who are:

• Experiencing severe hypoglycaemia without being aware of it
• Planning to undergo a kidney transplant.

Allotransplant is avoided in the following conditions:

• Poor kidney function 
• Women who are planning to become pregnant 
• The need for excess insulin (e.g., more than 50 units/day for a person who weighs 70 kilograms) 
• Bodyweight of more than 85 kilograms

Autotransplant is not performed if you have type 1 diabetes.

Before undergoing this procedure, you will need the following preparation:

• You will have a physical examination and the doctor will review your medical history. He/she may also order a few diagnostic tests to assess the severity of diabetes and overall health before this procedure. These tests include:
  • Chest X-ray 
  • 24-hour urine test 
  • Blood tests
  • Electrocardiogram (ECG)
  • Kidney scan: To assess the functioning of your kidneys as the anti-rejection medicines given after the procedure can affect kidney function.
• Tell your doctor about all the medicines that you take, including over-the-counter medications, herbs, minerals, vitamins, and supplements.
• You will need to fast for a few hours before this procedure.
• Your doctor may ask you to restrict the intake of blood-thinning medications (e.g., warfarin, aspirin, or ibuprofen) for at least two weeks before this procedure.
• He/she will also ask you if you are allergic to any medicine, food, or surgical components like iodine, tape, or latex. Read more: Allergy symptoms
• Arrange for a friend or family member to give you a ride home after this procedure.
• Smoking cessation may improve your recovery after the surgery.
• You will be asked to stop the use of short-acting insulin (e.g., Novolin) for a few hours before this procedure.
• Your surgeon will ask you to sign an approval or consent form if you agree to the procedure.

Preparation for the surgery:

Generally, after the admission procedure, the following steps are performed:

• You will need to change your clothes and wear a hospital gown.
• The medical staff will start an intravenous (IV) line in your arm to administer insulin and glucose. Your glucose levels will be monitored continuously. Depending on these levels, the amount of glucose and insulin will be adjusted. 
• They may also use this IV drip to give you painkiller and sedative medicines before the implantation. 
• In autotransplantation, a total pancreatectomy will be done under general anaesthesia to remove the pancreas, which will be sent to the laboratory for isolation of islet cells. You will be monitored in the intensive care unit (while still asleep) until the islet cells will be ready for transplant.

In allotransplantation, you may be given local or general anaesthesia while the islet cells from the pancreas of the donor are readied for transplantation.

Transplantation procedure:

Once islet cells are ready for transplant, you will be taken to the Interventional Radiology department to perform the following steps:

• The surgeon will make an incision on your abdomen.
• Through the incision, he/she will insert a catheter (a thin, flexible tube) into the portal vein of your liver with the help of an X-ray or ultrasound.
• He/she will slowly inject islet cells through this catheter into your portal vein.
• Once this is done, the surgeon will close the incision using stitches.

It may take 15 to 30 minutes to transplant the cells inside your liver.

 After the allotransplantation, immunosuppressants may be given to you through an IV line or through your skin.

After the procedure, your hospital stay may vary from four to 10 days. During your stay, you can expect the following:

• Your doctor will constantly monitor your blood sugar levels, and insulin will be provided to you intravenously till the time the transplanted islet cells start functioning.
• You will undergo an ultrasound scan to check for any indications of bleeding inside the portal vein. 
• A blood test will be performed to monitor the health of your kidney, liver, and the amount of anti-rejection medication in your body. 
• You can take food and drink, as usual, four hours after the surgery.

Once you reach home, you will need to take care of yourself as follows:

• Glucose monitoring: Monitor your blood sugar level up to seven times a day until follow-up. This will help to keep a track on the production of insulin by the transplanted cells.
• Medications: Your doctor may prescribe a list of medicines after the surgery. This include:
  • Painkillers
  • Anti-rejection medicines (after allotransplantation)
  • Insulin (implanted cells may take six to 12 weeks to produce insulin)
  • Preventive medications (to reduce the side effects of immunosuppressants)
  • Cholesterol and blood pressure-controlling medicines
• Diet: Follow a healthy diet that will keep your blood sugar level in control.
• Incision care:
  • Keep your wound dry and clean.
  • Avoid wearing clothes that rub on the operated area.
  • You may shower on the day after the surgery or whenever advised by your doctor.
• Activities: 
  • You may be able to resume your job two months after the implantation. 
  • Avoid doing strenuous activities or lifting heavy objects for six to eight weeks.
  • Avoid driving until your course of painkillers is completed.

When to see the doctor?

Notify (call or visit) your healthcare practitioner immediately if you are experiencing the following symptoms after this surgery:

• Fever 
• High or low blood sugar 
• Warmness, redness, or swelling at the incision site 
• Inability to eat or drink for a day
• Drainage from the wound 
• Chills 
• Cough
• Severe nausea or vomiting
• Chest pain
• Shortness of breath 
• Increasing pain at the incision site

This surgery is known to carry the following complications:

• Infection
• Bleeding 
• Pain 
• Abnormal liver blood test results 
• Blood clots 
• Damage or injury to an organ 
• Increase in need of self-injected insulin due to the reoccurrence of diabetes symptoms

Additionally, allotransplantation along with anti-rejection medications may possess the following risks: 

• Cancer 
• Rejection 
• High blood pressure
• Increase in cholesterol level
• Worsening of kidney function

You will need to visit your healthcare provider frequently to alter/reduce the dose of insulin. Your follow-up meetings may be scheduled in the following manner:

• Week one to two: thrice a week 
• Week three to six: twice a week
• Week seven to 18: once in every two weeks 
• Week 19 to up to a year: once a month
• After one year: every three months

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.