From Organ Transplantation to Cell Therapy
Seance of wednesday 08 september 2021 (Séance en hommage à Jean-Michel DUBERNARD)
DOI number : 10.26299/keev-rn86/emem.2019.1.014
Abstract
Before distinguishing himself by performing the first hand and face transplants, Professor Dubernard was one of the pioneers of pancreatic transplantation in the 1980s.
The goal of pancreatic transplantation is to replace the islet of Langerhans beta cells destroyed by autoimmunity in type 1 diabetes. It is most often performed simultaneously with a kidney transplant in patients with end-stage diabetic nephropathy. and is currently associated with excellent results in this indication, with an insulin-independence rate of more than 80% at 5 years.
However, pancreatic transplantation is an aggressive procedure with a high rate of complications. For this reason, the method of transplantation of isolated islets of Langerhans was developed as a minimally invasive procedure. The islet isolation and purification process is technically complicated and requires a dedicated laboratory and trained personnel. The functional results are slightly inferior to those of pancreas transplant, but the complication rate is remarkably low. The preferred indication is transplantation of islets alone for the management of severe hypoglycemia, which it manages to abolish almost perfectly.
The need for lifelong immunosuppression as well as the shortage of organ donors represent the limitations preventing the access to allotransplantation of beta cells (pancreas or islets) to all patients with type 1 diabetes. A bioartificial pancreas, immunoprivileged and built from stem cells or xenogenic islets, represents a potential future solution, the current advances of which are discussed in the last section of this article.
The goal of pancreatic transplantation is to replace the islet of Langerhans beta cells destroyed by autoimmunity in type 1 diabetes. It is most often performed simultaneously with a kidney transplant in patients with end-stage diabetic nephropathy. and is currently associated with excellent results in this indication, with an insulin-independence rate of more than 80% at 5 years.
However, pancreatic transplantation is an aggressive procedure with a high rate of complications. For this reason, the method of transplantation of isolated islets of Langerhans was developed as a minimally invasive procedure. The islet isolation and purification process is technically complicated and requires a dedicated laboratory and trained personnel. The functional results are slightly inferior to those of pancreas transplant, but the complication rate is remarkably low. The preferred indication is transplantation of islets alone for the management of severe hypoglycemia, which it manages to abolish almost perfectly.
The need for lifelong immunosuppression as well as the shortage of organ donors represent the limitations preventing the access to allotransplantation of beta cells (pancreas or islets) to all patients with type 1 diabetes. A bioartificial pancreas, immunoprivileged and built from stem cells or xenogenic islets, represents a potential future solution, the current advances of which are discussed in the last section of this article.