Long-term Outcomes of Clinical Islet Transplantation Using Donors After Cardiac Death: A Multicenter Experience in Japan

An obstacle to generally use of islet transplantation is an insufficient supply of cadaveric pancreas. In Japan, donors after cardiac death (DCD) are not deemed suitable for whole-organ pancreas transplantation and can provide a source of pancreas for islet transplantation. However, the long-term outcomes and the utility of DCD are still controversial in the clinical setting. Here, we summarize the long-term outcomes of islet transplantation employing DCD as reported to the Japan Islet Transplantation Registry. Sixty-four islet isolations and 34 islet transplantations were performed in 18 type 1 diabetic patients under cover of immunosuppression with basiliximab, sirolimus and tacrolimus. All donors were DCD at the time of harvesting. The mean follow-up was 76 months. Islet transplantation employing DCD can relieve glucose instability and problems with hypoglycemia while the graft is functioning. However, islets from DCD might be associated with reduced long-term graft survival. Further improvements in the clinical outcome by modification of islet isolation/transplantation protocol are necessary to establish islet transplantation using DCD.