A decade ago, islet transplantation was just an experimental procedure confined to labs across Australia. Today, thanks to Government support driven by JDRF advocates, islet transplantation has been a reality for a group of eligible adults with type 1 diabetes (T1D), and there are intensive research efforts behind making the procedure even wider-reaching.
Islet transplantation involves implanting insulin-producing islet cells from a human donor into the liver of a person with T1D. The aim is to reduce the frequency and severity of hypoglycaemic episodes and potentially achieve insulin independence. Usually, more than one islet transplant is needed to maintain benefits, and drugs to prevent an immune attack (immunosuppressants) on the implanted cells are also part of the therapy. Because of this, islet transplantation is currently limited to people who have unstable T1D, particularly those with hypoglycaemic unawareness who suffer recurrent and severe hypoglycaemic episodes.
The transplantation of clusters of islet cells is minimally invasive and can eliminate severe hypoglycaemia and often reduce or eliminate the need for daily insulin injections, improving quality of life. Islet transplants are carried out in a hospital Radiology Department by putting a plastic tube (a cannula) into the portal vein – a large vein in the liver – under local anaesthetic.
Like all human transplant procedures, recipients currently need life-long immunosuppression for the procedure to be successful. Research advancements have seen a reduction in side effects and researchers are continuing to make progress towards reducing or eliminating the need for immunosuppression in the long-term. Islet transplantation is a much less invasive procedure than a whole organ transplant, which was the only option before islet transplantation became available. In fact, August marked the 30th anniversary of pancreatic transplants in Australia. Thanks to advancement from whole pancreatic to islet transplants, pancreatic transplants are now mostly reserved for people who also need a kidney transplant.
Research from St Vincent’s Hospital Melbourne presented at the recent ADS/ADEA conference highlighted that islet transplantation saves lives of people with unstable T1D. The study investigated outcomes of people who were referred to one of the three Australian Islet Cell Transplant Programs (St Vincent’s Hospital Melbourne, Westmead Hospital Sydney, Royal Adelaide Hospital) for islet transplantation in Australia but didn’t go through with it or who were not eligible. They found that those who undergo the procedure have much better health outcomes than those that don’t, indicating this can be a life-saving therapy.
The research especially highlighted the need to review inclusion criteria to see if more people could be eligible. There’s also a need to investigate alternative treatment options for people who are referred for the procedure but who are not eligible.
JDRF was instrumental in bringing islet transplantation out of the lab and into clinics. The first Kids in the House event in 2003 saw advocate families descend upon Parliament House, focused on achieving bipartisan support for islet transplantation research. In 2004, the Federal Government committed $30 million to fund Australian research into islet transplantation through to 2011. During this time, 18 people received one or more islet transplants.
As of 2016, 53 people have received an islet transplant, and 18 of these are still insulin independent.
At the conclusion of the program, JDRF recommended that the program become nationally funded. As a result, an Australian Islet Transplant Consortium was established. The Consortium has two islet isolation facilities located in Melbourne and Sydney and performs transplants in Melbourne, Sydney and Adelaide, servicing eligible recipients from all Australian states and territories.
Ongoing islet transplantation research
While islet transplantation is a safe procedure, there is need for more research on all its aspects to refine it even more and make it more widely available. For example, we want to find ways to implant new cells without the immune system attack. To make the procedure available for more people, including children, we need to find a way to reduce or remove the need for immunosuppressive drugs. Currently, all transplants need human donors, so we want to find ways to produce an endless supply of insulin producing cells, from stem cells or from other cells already found in the pancreas.
To achieve this, there is a vast amount of ongoing research, in Australia and globally. JDRF- funded research includes encapsulation techniques to protect islets such as artificial skin and membrane systems, and modification of islet cells to allow them to fend off the immune system attack. The T1DCRN is funding a large trial investigating drug-free approaches to immunosuppression to protect implanted islets. This is led by Professor Philip O’Connell and the Westmead group.
I’m interested, what do I do next?
Speak to your endocrinologist to discuss your suitability for the procedure. Or, contact the islet cell transplant nurse responsible for your state. If you’re in Victoria or Tasmania contact Kathy Howe at firstname.lastname@example.org. In NSW, ACT, QLD, contact Trish Anderson at email@example.com and SA, NT, and WA, Toni Radford at firstname.lastname@example.org.
The islet transplantation website can be found here.