University of Maryland Medical Center is the only Baltimore area hospital to perform procedure
William Lackey and Doris Holzman answer questions about how their islet cell transplants changed their lives at a recent news conference.
Islet cell transplants represent a promising treatment option for some patients with Type 1 diabetes who have problems controlling their blood sugar through diet and daily insulin injections, according to transplant surgeons at the University of Maryland Medical Center who perform the procedure.
The medical center has successfully performed islet cell transplants for five patients. Two had Type 1 diabetes and three had the transplant to prevent diabetes after having their pancreas removed to treat severe chronic pancreatitis. The University of Maryland Medical Center is the only hospital in the Baltimore area to offer the procedure.
To learn more about our islet cell program or to see if you might be a candidate for this procedure, please call 1-800-492-5538.
Using state-of-the-art technology, doctors extract the islet cells from a pancreas, purify them and inject them into the patient's liver, where they can thrive. The goal is to have the cells produce enough insulin to control blood glucose levels without insulin injections.
"An islet transplant is an effective treatment to help stabilize blood sugar levels and allow some patients to stop taking insulin entirely," says David B. Leeser, M.D., clinical director of the islet cell transplantation program at the medical center and a clinical instructor of surgery at the University of Maryland School of Medicine. "We are very encouraged by the results we have seen so far."
Dr. Leeser says the Type 1 diabetes patients who are the best candidates for these transplants have difficulty controlling their blood sugar despite taking multiple insulin injections each day and working closely with an endocrinologist and diabetes educator. Without good blood sugar control, people may suddenly lose consciousness, and they are also at risk of serious complications, such as kidney failure, cardiovascular disease or blindness. An islet cell transplant for diabetes patients does not require surgery, but patients must take anti-rejection drugs following the transplant.
William Lackey, 60, of Lititz, Pa., who has battled Type 1 diabetes since he was 5 years old, received an islet transplant last month and now is taking half as much insulin. "It's working, and the procedure wasn't invasive at all," the retired salesman says, adding that he has only a tiny scar from where the islet cells were infused.
Mr. Lackey says that he was injured in several automobile crashes and a motorcycle collision after blacking out when his blood sugar dropped suddenly. His goal in having the transplant? "I just want to be able to walk out the door without fear," he says.
Another patient, a 36-year-old Delaware woman with Type 1 diabetes, has had three islet cell transplants at the medical center since 2002. She takes only small amounts of insulin and soon may not need to take insulin at all. Most patients need more than one transplant to produce enough insulin to stop their insulin injections.
"Even those patients who are not able to get off insulin completely can benefit from an islet cell transplant because their blood sugars are easier to control," says Kristi D. Silver, M.D., an endocrinologist who is an associate director of the University of Maryland Joslin Diabetes Center and an assistant professor of medicine at the University of Maryland School of Medicine.
The University of Maryland Medical Center also performs islet cell transplants for patients with severe chronic pancreatitis immediately after they have surgery to remove their pancreas. For some patients, surgery is the only cure for treating severe chronic pancreatitis, an inflammation of the pancreas that causes excruciating pain and prevents them from eating normally.
"Without a pancreas, these patients would become severely diabetic and suffer from wide swings in their blood glucose levels," Dr. Leeser says. "To help prevent that, we use the patient's own islet cells for the transplant. These patients have a 50 to 75 percent chance of not needing insulin after the transplant. If they do need insulin, it's usually a relatively low dose."
All three patients at the medical center who received an islet transplant after having surgery to remove their pancreas do not need to take insulin. One of the patients, Doris Holzman, 48, of Beach Lake, Pa., received a transplant in March. "The surgery has given me my life back. Before, I was in so much pain and had to eat through a feeding tube. Now, I can eat normally again, and I don't have to take insulin to control my blood sugar. The islets are producing enough insulin on their own," she says. She and the other pancreatitis patients also take enzymes to help them digest food.
Patients with Type 1 diabetes receive islet cells from a donated pancreas in what are called allogeneic transplants. The medical center is conducting a federally funded clinical study to see if these transplants stabilize or reverse complications of Type 1 diabetes and eliminate low blood sugar. Pancreatitis patients receive infusions of their own cells, which are called autologous transplants.
"Our success with islet cell transplants illustrates the kind of innovative therapies that our transplantation program is known for and underscores our long-standing commitment to helping patients with diabetes," says Stephen T. Bartlett, M.D., the acting chief of surgery at the University of Maryland Medical Center and professor of surgery and medicine and the acting chairman of the Department of Surgery at the University of Maryland School of Medicine.
For several years, the medical center has been a national leader in performing pancreas transplants. "We believe that islet transplants represent an exciting treatment option for some people with Type 1 diabetes who struggle to control their blood sugar with insulin and are most at risk for life-threatening complications from diabetes," Dr. Bartlett says.
"We also have had considerable success in preventing surgically induced diabetes in patients with severe pancreatitis," he says. He notes that surgeons are often able to obtain a larger number of healthy islet cells from a patient's own pancreas than from a donated one.
Type 1 diabetes destroys insulin-producing beta cells in the pancreas, which are located in nests of cells called the Islets of Langerhans. About 1 million people in the United States have this type of diabetes; most of them develop the disease as children. Because their bodies produce no insulin, patients must manage their blood sugar through insulin injections and diet.
Islet cell transplantation has been performed since the late 1970s, but a group of Canadian doctors improved the method several years ago. Surgeons use a digestive enzyme, plus heat and a shaking process, to dissolve the pancreas and retrieve as many healthy islet cells as possible.
The procedure used to transplant cells from a donated pancreas requires no incision and has few complications. Guided by sophisticated imaging equipment in Interventional Radiology, doctors inject the cells into the patient's liver through a catheter inserted into a major blood vessel, the portal vein. In transplants using the patient's own cells, the transplant is performed in the operating room following surgery to remove the pancreas.
One of the main drawbacks to islet cell transplantation to treat diabetes is the lack of availability of donated islet cells, and researchers at the University of Maryland Medical Center are looking for other ways to increase the supply, such as growing insulin-producing cells from stem cells and pancreatic ductal tissue. They are also trying to increase the length of time a pancreas can be stored prior to extracting the islet cells by using a special pump to help preserve the tissue.
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