Out of the Box Grafting Hopes Huntington's Disease

Grafting Hopes

Grafting hopes

 Out of the Box Grafting hopes Huntington's Disease Information for Grafting Hopes

Research into transplanting tissues from the pancreas holds out the promise of breakthrough

 treatments for many people with diabetes in the future.

But for some, 

pancreas transplantation already represents a very real hope.

To look at it, 

you wouldn’t think that the pancreas (illustrated left) could perform one of the body’s most delicate and important tasks. 
But housed within this rather shapeless, 

elongated organ, 

which hangs just below the liver, 

is the islet cells - the cells whose destruction causes 
Type 1 diabetes. 
In people who don’t have Type 1 diabetes, 

these cells release a continuous background ‘trickle’ of insulin, 

with sudden spurts after a meal to deal with rises in blood glucose.

We still have a lot to find out about exactly how these complex processes work, 

so when people with diabetes have to mimic the process it’s hardly surprising they can find it 

so challenging. 

Much of the research funded by Diabetes The UK is looking for ways to make this challenge easier, 

but wouldn’t it is simpler just to replace the pancreas itself?

Some of the most exciting research being undertaken in diabetes today is looking at ways to put this theory into practice. 

The greatest promise seems to lie in transplanting individual islet cells.
researchers believe that it will take several years before this approach can become more widely available.

In the meantime, 

whole pancreas transplants have become an increasingly realistic option for a small minority of people whose diabetes leaves them in urgent need. 


People like Anne Reid*. 
By her mid-30s, 

Anne was spending most of her life in hospital. 
 And because my diabetes had been hard to control for over 20 years,
 I was very fearful of complications -,, especially in my kidneys and nerves.
 I already had very little sensation in my hands and feet."

In spite of her problems, 

Anne was surprised when her diabetologist suggested she have a pancreas transplant.

 "  Replacements are only for people on the verge of death, I thought I thought. 

You Should Care for   
But I spoke to the surgeon a few times and he explained a lot of things to me and put me in touch with some people in the US who’d had transplants. 

They were very positive and explained the pros and cons very clearly, 

which really helped me to make up my own mind."

Grafting Hopes Pros and cons

The decision to have a pancreas transplant is not an easy one to make. 
According to Pandey Hakim, 

a surgeon who has performed numerous pancreas transplant operations, 

"It’s a major surgical operation, and as such carries risks which have to be justified by the needs of the patient." 

The operation is only recommended for people between the ages of 20 and 50 who have either very poorly controlled diabetes or at least two secondary complications. 

And because of the risks associated with the surgery itself, 

the operation is also not recommended for people suffering from obesity.

Another the major problem is the drugs that people who receive a transplant pancreas have to take to prevent their immune system from attacking the new organ. 

The effectiveness of these anti-rejection drugs, 

which work by suppressing the immune system has improved considerably since pancreas transplants were first attempted in the 1960s, 
and through the 1990s medical research has led to new drugs which have increased the success rate of the operation still further. 

anti-rejection drugs also bring problems. 

Because they lower the body’s immune system they leave people more prone to infections and can have other unpleasant side effects, 

such as weakening bones and increasing the risk of cancer. 
As a result, 

• these operations are most common among people who need or have already 
• had a kidney transplant, 

will, therefore, 
be taking anti-rejection drugs anyway.

Nevertheless,

 in the last few years, 

the operation has become more common, 

 there has been a clear increase in its success rate. 
To date, over 10,300 pancreas transplants have been performed around the world.

 Most of these have been in the USA but the number of these operations performed in Europe and the UK has increased in recent years. 

At St Mary’s Hospital in London, 

where Pandey Hakim works, 

over 31 pancreas transplants have been performed since 1995.

According to Pandey,

 the hospital’s success rate has been very good. 

"List of Useful Approximately 80 percent of the transplanted pancreata still survive one year after the operation. for. 

And the results for these patients are very significant. 

There is a definite improvement in their health,

 glucose levels become entirely normal - they become insulin-independent and their quality of life is definitely improved.

" Pandey also suggests that the operation can help prevent complications and may even lead to an improvement in existing ones, 

in particular damage to the nerves. 

But he explains that, 

because most of the successful transplants have taken place comparatively recently, 

the full picture of their long-term effects has yet to emerge.

Pandey is part of a research team, 

which has had funding from Diabetes UK, 

looking into ways to improve this success rate. 

The project is trying to find ways of detecting signs that the transplant is being rejected.

 "We’re studying enzymes produced by the pancreas. 

We hope that by measuring these we can predict early rejection and then treat it before it’s too late."

Grafting Hopes Short supply

But however much the technology of transplanting whole pancreata improves, 

it can never overcome one major difficulty: the shortage of donated organs. 

This is a problem also for islet transplantation, 

 Diabetes UK has funded research to tackle this problem. 

For example,

 in Aberdeen Prof Kevin Docherty has been using genetic engineering technology to produce ‘artificial’ beta-cell lines for transplantation as an alternative to donated human tissue. 

The isolated islet approach could provide a treatment that would be far less invasive than the major surgery required by the whole pancreas transplants.

So is research into whole pancreas transplantation really just a blind alley?
 Pandey underlines the importance of this form of surgery as a practical option for people today. 

"If islet transplantation becomes successful it will, of course, supersede this type of operation. 

It will be so easy, you’ll just have to inject the cells into the liver and then use a straightforward cocktail of medications. 
That’s the hope. 

But it will probably take some time before this comes about. 

Until then, we need to do what we can for people who really need this operation."

For Anne Reid, the effect of the operation has been dramatic. 

"It’s allowed me a totally different lifestyle, 

away from the hospital. I’m able to get out and keep down a job - things I couldn’t do before."

"A transplant is not a magic wand. 
It improves your health and makes your life more flexible in many ways - especially your choice of food. 

But it imposes other constraints. 
You’re swapping one set of possible complications for another. 

It gives you freedom but doesn’t take away the possibility of things going wrong. 

I hope that in the future islet research will make possible similar treatment without the need for a big operation. 

In the meantime, for me, the operation has made a tremendous difference."

See also:

Sweet success is a support group for people undergoing a pancreas transplant is on a waiting list or has recently undergone the operation.

The full version of this article by Rob Saunders,

Diabetes UK’s Medical and Science Editor first appeared in Research Focus’ 

newsletter in Spring 2020.

*To protect the anonymity of our case study we have used a pseudonym.

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