Islet transplantation: steady progress and current challenges

Purpose of review Clinical islet transplantation has evolved rapidly in recent years and current clinical trials are showing the benefits of this therapeutic approach for patients with diabetes. New challenges are emerging and must be overcome in order to extend this therapeutic option to larger cohorts of patients who may benefit. This review summarizes the current state of clinical islet transplantation and progress made in translational research to address limitations. Recent findings Transplantation of pancreatic islets has proven efficacy in improving metabolic control and quality of life, and in preventing severe hypoglycemia in patients with diabetes. New clinical islet transplant programs are being established worldwide and the annual number of transplants continues to increase. Recent improvements in pancreas procurement, islet isolation, and purification techniques have led to more consistent islet yields and better utilization of cadaveric donor pancreata. Improved methods for islet assessment are being developed to predict islet potency. A better understanding of the causes of islet dysfunction will be helpful in designing targeted interventions for islet cytoprotection and reducing the number of islets required to achieve insulin independence. Implementation of safer immunosuppressive/tolerogenic regimens will permit widespread application of islet transplantation to restore P-cell function in the future. Summary The benefits of islet transplantation in managing patients with diabetes are tangible. Very encouraging data are emerging from the numerous clinical trials and from translational research ongoing worldwide that justify cautious optimism for the near future.