UW Hospital performs state’s first islet cell transplant

For years — forty, to be exact — Dan Quigley has lived with the routine, cumbersome task of injecting insulin into his body two or three times a day. The 53-year-old Door County man says, “For those of us who live with Type 1 (juvenile) diabetes, we know of no life without insulin.”

Sept. 18, a UW Hospital transplant team led by Jon Odorico, a UW transplant surgeon, delved into the cutting edge of medical technology by performing Wisconsin’s first pancreatic islet cell procedure on Quigley. Only a handful of medical centers in the world offer this procedure as a treatment option for diabetes. Currently, islet transplants are experimental and done only as clinical research.

“Pancreatic islet cell transplantation is a big step forward for diabetes research in that it offers the potential to eliminate insulin injections and control blood sugar without major surgery,” says Odorico. Islets (pronounced “eye-lets”) are cell clusters in the pancreas that release the necessary amount of insulin to maintain normal sugar levels in the body. Destruction of the islet cells leads to Type 1 (insulin-dependent) diabetes. Islet cell transplantation is the biological replacement of the islet cells.

Quigley — a computer consultant in Fish Creek, husband and father of tw — feels his chances are pretty good. “I read about this procedure about two years ago in the New England Journal of Medicine and I immediately called the UW Transplant Program to see if they offered it,” says Quigley. Quigley is referring to the ‘Edmonton Protocol,’ developed at the University of Alberta in Edmonton. Authors reported study results showing that they had effectively reversed dependence on insulin injection of diabetic patients using islet cell transplantation.

“Islet cells are extracted from the donor pancreas through a complex purification process,” says Odorico. The cells are kept alive in lab dishes until they’re infused through an IV directly into the liver via the patient’s portal vein using X-ray guidance. Because diabetes destroys a patient’s pancreas, doctors transfuse the new cells into the liver — where they turn out insulin as needed.

Patients remain awake throughout the procedure, although an intravenous sedative and local anesthetic are administered beforehand to relieve any patient discomfort. The procedure itself takes less than one hour. Because the procedure is minimally invasive, Quigley may return home within three to five days, whereas the traditionally transplanted patient remains hospitalized for up to two weeks.

Though islet cell transplantation is still considered experimental, recent advances in cell isolation and purification and better immunosuppressive drugs have allowed more successful results in clinical trials. Quigley is the first participant enrolled in the UW clinical study, which is designed to study the effectiveness of pioglitazone, a medicine that sensitizes the body’s cells to insulin, in combination with islet transplantation. The UW study will include 16 patients of two types: those who have had prior transplants and those who have not. Eligible patients must have poorly controlled diabetes and not be candidates for or not favor pancreas transplantation as a treatment option. Quigley qualifies because he’s a Type 1 diabetic at high risk for life-threatening, low-blood sugar episodes and is unaware that these events are happening.

The benefits associated with the procedure appear promising. “After we implant these cells into Type 1 diabetes patients, the transplanted islets can provide much better control of blood glucose than insulin injections do,” says Odorico. “We hope that with this tighter glucose control, the long-term complications from diabetes can be avoided.” Following islet cell transplantation, insulin injections will be slowly reduced over a one-month time period as the transplant gradually begins to function.

Risks associated with the procedure are minimal, says Odorico. “Subjects may have to receive more than one (and up to three) islet transplant procedures that may require subsequent hospitalization,” he says. Also, recipients must take anti-rejection drugs that can cause kidney and heart problems. Equally critical is the fact that the supply of donor pancreases doesn’t meet the potential demand.

Before islet cell transplantation was an option, pancreas transplant patients faced three treatment options. Because kidney failure may occur in certain cases of diabetes, the first and most common option is simultaneous kidney and pancreas transplant. The second alternative is to receive a kidney transplant first, usually from a live donor, then receive a pancreas transplant from a cadaver donor at a later date. Third, in a few cases, patients may receive a pancreas transplant alone, without a previous or simultaneous kidney transplant.

Pancreas transplantation was first performed at UW Hospital in 1982. Since then, the transplant program, one of the largest in the country, has performed more than 700 pancreas transplants. The United Network for Organ Sharing has ranked its patient success rates among the best for pancreas transplant centers nationwide. In 1983, Hans Sollinger, chair of organ transplantation at UW Hospital, developed the “Wisconsin technique,” an approach used nationwide in pancreas transplantation.

“UW Hospital is uniquely positioned to become a leader in diabetes research,” says Sollinger. “In addition to the clinical pancreas transplant and islet programs, research is underway with genetic engineering of liver cells programmed to produce insulin as well as stem cell research, which ultimately could become a source of insulin-producing cells.” Aside from Odorico and Sollinger, collaborators in the UW islet cell project include: Luis Fernandez, Debra Hullett and Nancy Radke.

Because islet cell transplantation is experimental, it’s only available to those who meet defined criteria. To be considered for participation in the UW Islet Cell Program, please call 608-263-2565.