Pancreas and Kidney/Pancreas Transplantation Program
Originating in 1992, the Pancreas Transplantation Program at Northwestern Memorial Hospital is one of the premier programs in the United States. Over the past 10 years, Northwestern Memorial has the largest and most successful pancreas transplant program in Illinois and consistently ranks among the top centers in the country, with surgeons performing 22 pancreas transplants in 2015. Transplant patient and graft outcomes continue to be excellent and compare favorably with local, regional and national outcomes.
There are several treatment options for patients with diabetes interested in pancreas transplantation for amelioration of type 1 diabetes:
Simultaneous pancreas-kidney transplantation (SPK)--for patients with type 1 diabetes and renal failure who are considering a kidney transplant. This makes it possible for both the kidney disease and diabetes to be treated with a combined transplant of both the kidney and pancreas from the same donor in a single surgery.
Pancreas after kidney transplantation (PAK)--for patients with type 1 diabetes with a functioning kidney transplant who continue to have diabetes. A pancreas transplant will ameliorate the diabetes without a significant change in the immunosuppression needed for the kidney transplant.
Pancreas transplantation alone (PTA)--for patients with severe diabetes that is difficult to control with conventional insulin therapy who still have normal kidneys and do not need a kidney transplant. Patients with labile diabetes or problems with hypoglycemia who receive a successful pancreas transplant will no longer require insulin therapy for nearly perfect blood sugar control.
The pancreas transplantation program at Northwestern Memorial offers all options.
Islet Cell Transplantation
Northwestern University is one of the premier centers in the exciting field of islet cell transplantation. Islet cell transplantation is an investigational therapy for treating diabetes in select patients through the infusion of insulin producing islets that replace the defective islets in patients with diabetes using a minimally invasive radiologic technique that avoids conventional surgery.
Very few islet transplants are performed annually in the U.S. Those that are performed are done under rigorous study protocols requiring state-of-the-art clean room facilities for islet isolation at academic institutions heavily supported by clinical research resources. Northwestern is such a center. In 1996 Northwestern performed the first islet cell transplant in Illinois. Islet cell transplantation is being performed for patients with type 1 diabetes in conjunction with the hospital’s National Institutes of Health (NIH) supported Clinical Research Unit.
During the last four years, Northwestern performed a total of 15 islet transplantations in seven type 1 diabetic recipients in several trials supported by the NIH. All seven patients achieved insulin independence after one or two islet infusions. Our rate of transplantation and success of islet manufacturing are among the top of all North American transplant centers funded by the NIH to participate in these trials. All of our transplant recipients under the NIH-funded trials have now exceeded at least 3 year follow up period, with the majority of recipients remaining insulin free. Since 2013, we have recruited additional type 1 diabetic patients for a new islet cell transplant trial with new immunosuppression regimens. In November 2014, we successfully transplanted our first patient under the new Northwestern protocol. Immediate insulin independence was achieved following single infusion of high quality human islets. In June 2015, a second patient was successfully transplanted under the same protocol, also achieving immediate insulin independence. Five additional patients are currently screened eligible and actively listed in UNOS awaiting their islet cell transplant. In addition, following the footsteps of our success in achieving transplant tolerance (a state that allows complete withdrawal of immunosuppression) in kidney transplantation, we are currently testing a robust tolerance strategy for islet cell transplantation in pre-clinical models, with the anticipation of launching a clinical trial for tolerance induction in islet cell transplantation in the near future.
The Northwestern islet cell transplant program takes a multidisciplinary approach to pre-transplant candidate assessment and post-transplant care for our islet transplant patients. In collaboration with our endocrine team, we have developed another clinical trial with the purpose of determining the most appropriate standard-of-care for glycemic control in patients with evidence of partial islet function. We are additionally developing a clinical trial protocol to examine recurrent autoimmunity in type 1 diabetic patients after receiving islet cell transplantation.