Transplantation of islets of langerhans in patients with insulin- requiring diabetes mellitus undergoing orthotopic liver transplantation - The miami experience

M. Clara Angelico, Rodolfo Alejandro, Jose Nery, Mark Webb, Rita Bottino, Shen Shen Kong, Theodore Karatzas, Les Olson, Andreas G. Tzakis, Camillo Ricordi

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Most patients with cirrhosis of the liver have detectable insulin resistance. In 60-80% of patients with cirrhosis, impaired glucose tolerance can be uncovered; approximately 20% of these patients eventually develop overt diabetes. Theoretically, insulin resistance and glucose intolerance could be improved or reversed by orthotopic liver transplantation alone or in association with a simultaneous transplant of pancreatic islet cells from the same donor. To investigate these possibilities we initiated a pilot study of simultaneous liver and pancreatic islet cell transplantation in seven patients with diabetes and liver cirrhosis. Donor bone marrow cells were also infused to enhance the acceptance of the grafts. Seven patients who received only orthotopic liver transplantation and donor bone marrow cells were used as historical controls. The preliminary results of this pilot trial suggest that islet cell transplantation in conjunction with orthotopic liver transplantation improves glucose metabolism in patients with liver cirrhosis in association with reduced insulin requirements and HbAlc levels. These results were evident in spite of pre- and post-transplant basal C-peptide levels that were unchanged. Further evaluation of the effects of orthotopic liver transplantation with or without islet cell transplantation will require a randomized prospective trial including accurate metabolic evaluation with the euglycemic insulin clamp technique.

Original languageEnglish (US)
Pages (from-to)144-147
Number of pages4
JournalJournal of Molecular Medicine
Volume77
Issue number1
DOIs
StatePublished - Jan 1 1999

Keywords

  • Islet cell transplantation
  • Orthotopic liver transplantation
  • Type 2 diabetes mellitus

ASJC Scopus subject areas

  • Medicine(all)

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