Thursday, August 9, 2012

Islets of Langerhans Transplantation

Goal of Transplantation

When you agree to have a transplantation, from a donor of their Islets of Langerhans from the Pancreas, the goal is to infuse enough islets to control your blood glucose level thus removing the need for insulin injections.

A successful transplant can slow or prevent the progression of complications like nerve, blood vessel and eye changes associated with diabetes. It should help with good control of blood glucose levels.

Unless you are receiving a transplant from an identical twin that contains cells with exactly the same DNA your immune system will think the transplanted cells are foreign bodies and produce anti-bodies to kill them.

This requires the administration of drugs that supress your immune system. You must continue to use some of the drugs for the rest of your life.

For different diabetes events these mugs are great participant gifts.


Procedure

Transplanted islets come from the pancreas of a deceased donor. The  pancreas is subjected to a mixture of purified enzymes called collagenases that isolate islets from the other pancreatic tissue. The researchers inject the enzyme solution into the pancreatic duct that runs the length of the pancreas. This causes the pancreas to swell. The donor pancreas is then cut up into little chunks, transferred to a Ricordi's Chamber where digestion takes place until the islets are separated out from the exocrine gland tissue. 

The pancreas has both endocrine products and exocrine products. 

For our sake, we are interested in the endocrine products,  insulin and glucagon. They are hormones that are secreted into the blood circulatory system directly when called upon to control blood glucose levels. They are found in the islets.

The products that digest our food in the small intestine are enzymes. They enter the small intestine through ducts. When tissue does that the products are referred to as exocrine. (Pass into a duct system - not the circulatory system)

The islets are separated from the exocrine debris in a purification process. During the transplant procedure a catheter (tube) is carefully guided through the upper portion of your abdomen and into the hepatic portal vein of the liver. This provides the way the islets are placed into the body where they can begin to function.

It takes a little time for the islets to attach to the new blood capillaries and to produce insulin. As the new islets ramp up for production of insulin the physician may order many tests to check blood glucose levels after the transplant. You may need to continue injections of insulin to help you bridge the gap until the new cells take over.

Immune System Depression

Like everything else there is no free lunch. If you have to suppress the immune system, to prevent the immune system from destroying the islet cell from an unrelated donor, you leave your  body more susceptible to other diseases that may enter you body. Your physician can inform you of those possibilities.

Three drugs currently used to suppress the immune system are Daclizumab (Zenapax), Sirolimus (Rapamune) and Tacrolimus (Prograf). Two of the drugs, Sirolimus and Tacrolimus, you must take for life. In conclusion, immune system suppressant drugs are not a cure. They provide a comfort level to allow a transplant to do its thing. The alternative is the destruction of the transplanted cells.

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