Pancreas and Islet Cell Transplantation

Type 1 diabetes mellitus (T1DM) affects millions of children worldwide, and its incidence is increasing. It is understood to be an autoimmune condition resulting in destruction of the insulin-producing beta cells within the pancreatic islets of Langerhans. The mainstay treatment is exogenous insulin replacement with the goal of controlling the disease in the acute stages and trying to maintain tight glycemic control to prevent the chronic complications of T1DM from developing in the longterm or reverse them if they have developed already. However, although novel types of insulin and sophisticated methods of insulin delivery are being developed, none of these can yet mimic the sophisticated mechanisms of glucose homeostasis within the normal pancreas, and insulin therapy fails to replace the other islet hormones essential for integrated glycemic control. Transplantation is currently the only form of treatment that offers reversal of T1DM by replacing the destroyed islets. This can be in the form of a major whole pancreas transplant or a minimally invasive pancreatic islet cell transplant. This chapter outlines the rationale, methods, results, and future opportunities for islet transplantation in children.