Using living donors could allow many more patients to get transplants sooner, and the quality will be much better coming from a living donor than from the donated organ of a dead person. An Edmonton surgeon who pioneered insulin-cell transplants to treat diabetes and a medical team in Kyoto, Japan, have performed the world’s first transplant using a living donor.
Dr. James Shapiro and Japanese surgeons removed part of the pancreas from a 56-year-old woman, extracted insulin-producing cells called islets and successfully transplanted them in the woman’s 27-year-old daughter. Shapiro leads a team at the University of Alberta that developed islet transplants under what is known worldwide as the Edmonton protocol.
The university announced Thursday that the Japanese transplant took place Jan. 19. Shapiro said both of the women are doing well.
Being able to use living donors could allow many more patients to get transplants sooner, he said. As well, the quality is much better coming from a living donor than from the donated organ of a dead person.
"I think it is a dramatic step forward," Shapiro said.
"Our waiting lists for islet transplantation at the University of Alberta today are increasing all the time and some of our patients have to wait two, sometimes three years, or sometimes longer, for their transplant.
"These patients have very unstable diabetes. If they could be treated sooner it would be helpful to them."
Shapiro has a long association with surgeons at Kyoto University where he learned how to do liver transplants using living donors. He said he proposed to them they start an islet transplant program using living donors because there are few organ donors in Japan.
"They are culturally averse to brain-dead organ donation but they do have a very strong living donor program in kidney and liver transplantation." The pancreas is the organ that produces enzymes for digesting food and releases insulin to regulate blood-sugar levels.
The islet transplants developed in Edmonton are being used to treat patients with severe Type 1 diabetes where appropriate. The cells are extracted from a donor pancreas and injected into the recipient’s liver. If successful, the cells begin producing insulin. The patients must take anti-rejection drugs for the rest of their lives.
To date, 72 Canadians have had the transplant in Edmonton since the first one was performed in 1999. In the majority of cases, patients have been able to stop their insulin injections.
Worldwide, almost 500 transplants have been done using the Edmonton protocol in the last few years.
The transplanted islets began producing insulin within minutes, explains Dr. Shapiro. "The reason I’m so excited about this is because normally the Edmonton Protocol is done with islets from brain-dead organ donors. Those islets are often severely injured from cold storage, transport time and the pancreas is severely damaged by toxins which circulate in the blood stream after brain death."
"Our expectation is that these islets from near-perfect organs will work better, although it’s too early to tell," he says. The recipients use the same drugs to prevent organ rejection as are used in the Edmonton Protocol.
Dr. Shapiro was invited to participate in the operation in Kyoto, Japan, where he originally did living donor liver transplant training with Dr. Tanaka. Dr. Masumoto was previously based in Seattle and had been involved in Dr. Shapiro’s international trial of the Edmonton Protocol before returning to Japan. Dr. Shapiro first suggested the idea of starting a living donor islet transplant program in Kyoto while lecturing there three years ago. Cadaveric organ donors are scarce in Japan, and living donation has very established roots in liver and kidney transplantation there.
"Living donor islet transplants could allow many more desperate patients with type 1 diabetes to get successful islet transplants," says Dr. Shapiro. "The donor operation is relatively safe, but is not entirely devoid of serious potential risk," he added.
A shortage of donor islet cells is the biggest obstacle preventing implementation for all patients who need it, Shapiro added.
The mother of the diabetic daughter was in perfect health, while her daughter has been on the cadaver donors transplant list since September 2004. Before the surgery, the woman had been subject to severe low blood sugar coma attacks, and her glucose control has been transformed by the transplant.
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