Islet Transplant Program
About Islet Transplant
Islet Transplant Overview
Islets are insulin-producing cell clusters found in the pancreas, which is a six- to ten-inch organ that lies behind the stomach. Each islet cluster is about the size of a grain of salt and contains a few thousand cells. A healthy pancreas has approximately a million islet clusters.
Glucose is the fuel that provides energy to cells. Insulin allows glucose from the bloodstream to enter cells. Without insulin, cells are deprived of fuel, and they begin to starve. As the cells starve, the level of glucose in the bloodstream rises to dangerous levels.
In type 1 diabetes, islets in the pancreas are destroyed by the body's immune system. Without islets, the body cannot produce insulin. People with type 1 diabetes require several injections of insulin each day. They must follow a strict diet and monitor their blood glucose carefully. Sometimes, even the most diligent patients cannot completely control their blood sugar levels. Diabetes that is very difficult to control is called brittle diabetes.
Why Islet Transplantation?
Islet transplantation can restore insulin production by replacing the islets that have been destroyed. When insulin production is restored, blood glucose levels stabilize, and the health risks associated with low and high blood sugars are greatly reduced.
What Is an Islet Transplant?
The islet cell transplant process begins when islets for transplantation from a donated pancreas become available. During the islet transplantation procedure, the islets are infused into a blood vessel that leads to the liver. The islets from the pancreas are also separated from other cells through a highly complex process called "islet isolation." The islets are then infused and lodged into the liver of the recipient, where they are able to detect the level of glucose in the blood and produce the correct amount of insulin. Recent advances in islet isolation have resulted in sustained insulin independence in people with type 1 diabetes, which may make islet transplantation more common in the foreseeable future.
Emory’s Islet Transplant Program is the only islet transplant center in the state of Georgia, and for over 10 years, our team of transplant surgeons have been performing islet transplantation under clinical trial using a protocol known as the Edmonton Protocol.
Islet Transplant Wating List
After being listed for transplant, it is your responsibility to make sure you can be reached at any time. We recommend that listed patients keep a cell phone on their person at all times.
Patients may be called at any time of the day or night and must be able to come to the hospital as soon as possible. Patients waiting for transplant must have transportation to the hospital available at all times and have people ready to take over responsibilities at home and work.
When a donor becomes available, a transplant coordinator will contact you about a possible transplant. You'll be given instructions for arriving at and checking into the hospital.
You will continue to check blood sugars as usual and will get instructions on when to refrain from eating in anticipation of surgery. After checking in at the hospital, you'll be given an IV for medications. Final testing is done to ensure that you are healthy enough to undergo the transplant procedure. These tests may include blood and urine tests, an EKG, chest X-ray, and a health history and physical exam. You will also sign a consent form for the procedure.
It is possible that you may be called into the hospital multiple times before actually receiving your islet transplant.
Anxiety While Waiting is Normal
Helpful ways of coping with the stress of waiting for a islet may include:
- Keeping up your normal daily routines as much as possible.
- Talking with someone on your team to help sort out your feelings. This could include your transplant coordinator, social worker, or physician. While waiting for a transplant, just "checking in" with your coordinator on a regular basis allows you to get questions answered and talk about any anxiety you may be having.
- Contacting the Georgia Transplant Foundation's Mentor Project. This program has been developed to match people who are new to the world of transplantation with people who are living with a transplant. You can get more information on the Mentor Project during your evaluation.
Islet Transplant Surgery
Islets for transplantation come from someone who has had an accident or medical event which has led to brain death. The donor's family has made the decision to donate this person's organs for transplant.
Preparing the Islets
The isolation procedure must begin within hours after the donor pancreas is procured. The process takes place in the Emory Islet Isolation Laboratory and requires a team of four to five highly trained people.
Isolating and preparing the islets for transplant takes eight to 12 hours. A catheter is placed into the ductal system of the pancreas, and an enzyme is injected into the gland. The enzyme breaks down the connections between the cells of the pancreas. The pancreas is then placed in a special chamber with marbles. Fluid is pumped in and out of the chamber as it is shaken. The pancreas is broken down into tiny pieces of tissue, and the islet tissue is separated from the rest of the pancreatic tissue. If a sufficient number of islets are isolated, they are prepared for transplant and the patient is prepared for surgery. If there are not enough islets in the final count, the transplant will be cancelled and the patient will be sent home. A patient could be called to the hospital several times before receiving a transplant, since the number of islets available is not known until the end of the isolation process.
The Islet Transplant
The patient will be given his or her first dose of immunosuppressants right before the transplant procedure. The transplant procedure may take place in the operating room or in Interventional Radiology and is performed by a transplant surgeon. In the operating room, general anesthesia is used, and the patient is asleep for the entire procedure. In Interventional Radiology, sedation is used.
The abdomen is washed with disinfectant and draped with sterile towels. The surgeon makes an incision in the abdomen. A catheter (thin plastic tube) is placed into a vein, and a bag containing the islets is attached to this catheter. The islets flow into the vein and are carried by the blood flow into the liver, where they lodge in smaller veins and capillaries. The infusion takes 15 to 30 minutes; the entire surgery takes up to two hours.
Interventional Radiology Procedure
The skin on the right side of your chest (in between your lower ribs) will be cleaned to make it sterile. A numbing medicine will be injected into a small area of skin on your right side. Then, a radiologist will use ultrasound, X-rays, or CT scan to guide the needle during the procedure. The radiologist will inject dye to help find the main vein that carries blood from the intestines to the liver (the portal vein). After identifying the vein, the radiologist will place a thin plastic tube into the vein. The islets will be injected slowly through this tube and carried by the blood into the liver.
Once the islet infusion is complete, the catheter is removed and the incision is closed using sutures or staples. Once the patient is awake, he or she is transported to the recovery room and monitored for about an hour. After returning to the hospital room, the nursing staff continues to monitor the patient's vital signs and blood sugars frequently. After about six hours, blood is drawn for lab work. An abdominal ultrasound is performed within 24 hours after the transplant to check the liver for bleeding around the blood vessel where the islets were infused. If all the test results are satisfactory, the patient is discharged from the hospital two days after the transplant.
After Islet Transplant Surgery
Before being released from the hospital, the patient and the patient's family will be thoroughly instructed on post-transplant care. If the transplant recipient takes good care of him or herself, chances of success are greatly increased.
The patient must monitor blood sugars and insulin requirements very carefully after the islet transplant. Insulin may be necessary, but the amount should be significantly less than before the transplant. The transplant team will help determine adjustments in insulin dosages. In order not to stress or overwork the islets, blood sugars should be kept in a target range. It will take time for the islets to "engraft," or adapt to their new home and start making insulin. Some patients will be able to discontinue insulin prior to discharge from the hospital.
All follow-up appointments and bloodwork take place at the Emory Transplant Center. Blood tests will be performed according to study protocol. These tests are done "fasting" (nothing to eat after midnight).
After transplant, patients will continue to do a finger stick test to monitor blood glucose seven times a day until off insulin. Once the patient is off insulin, he or she will do a finger stick test four times a day for a year. After that, he or she will test sugars once a day indefinitely and seven times a day for two days at the beginning of each month.
Going home after your transplant is exciting, but it can also be overwhelming. Before you go home, we will thoroughly review with you and your family what you need to do to take care of yourself and your new kidney. Your transplant coordinator, pharmacist, social worker, and nurses will begin preparing you for discharge the day after surgery.
You need to weigh yourself every day. Please try to do this at about the same time each day (preferably in the morning after you have emptied your bladder) and while wearing about the same amount of clothing. If you have gained more than three pounds in a day, or more than five to seven pounds in a week, you should call the transplant team. This weight gain may be a side effect of your medications or possibly a sign of transplant rejection.
Medical Alert Identification
We suggest that you obtain a special medical alert bracelet or necklace. In case of a car accident or other type of emergency, this will inform health care professionals that you have had a transplant. The identification bracelet or necklace can be purchased at many pharmacies or ordered through the mail for a nominal cost.
Clinic Visits and Lab Tests
Your kidney transplant follow-up appointments will take place in the Outpatient Transplant Clinic. On the day of discharge, we will schedule your first appointment.
For the first four weeks after your transplant, you must come to Emory twice a week for a follow-up lab work and typically a weekly visit with the transplant team. After four weeks, if all is going well, visits and lab work will be needed less frequently. Eventually, you will need a follow-up appointment at Emory only once a year.
Routine Blood Tests
Monitoring your blood through lab tests is one way that we can make sure your kidney is working well and check for possible side effects of your medications.
Ureteral Stent Removal
Most transplant recipients will have a ureteral stent placed as part of their kidney transplant surgery. The urine produced by your new kidney flows to your bladder through the ureter. The ureter came with the donor kidney and was connected to your bladder with a small incision. The stent is a thin, hollow tube which is placed inside the ureter to keep it open and allow the connection to your bladder to heal.
The ureteral stent needs to stay in place for about six weeks after the transplant. By this time, healing will be complete and your stent can be removed. A urologist who works with the transplant team will remove the stent during a brief procedure called a cystoscopy.
When to Call the Transplant Team
You should call the Transplant Team if you experience any of these symptoms, or any time anything about your health changes, even if it is not related to your transplant:
- Temperature of 100°F or greater
- Blood pressure greater than 170/100 for two readings in a row
- Weight gain of more than three pounds in a day or five to seven pounds in a week
- Cough, shortness of breath, sore throat, chills
- Nausea, vomiting or stomach pain
- Decreased appetite
- Blood in the urine or bowel movements, painful urination
- Increased pain, redness, or pus-like drainage at the incision
- Pain, tenderness or swelling in the area of the new kidney
- Feeling unusually tired
- Persistent headache or flu-like symptoms
- Any unexplained rash, sores, or bruising
- Swelling of the hands, feet or ankles
- Inability to take medications for any reason
- Anything that concerns you about your health
How Can We Help You Today?
Need help? We will be delighted to assist you today, so please call us at 404-778-7777. We look forward to hearing from you.
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