How can I apply to the Clinical Islet Program?

If you are interested in receiving an information and application package, there are 3 methods by which this can be obtained:

1. E-mail your name, home address including postal code and phone number with area code to isletprogram@islet.ca.

2. Check out our website at www.islet.ca for the online application and information package.

3. Call our application line at +1 780 407-1501.

Are the current results of islet transplantation improving?

Our results and progress are summarized in this article

Am I a candidate for islet transplantation?

You will benefit most from an islet transplant if you have Type 1 diabetes complicated by:

  • frequent or severe episodes of hypoglycemia

  • hypoglycemic episodes with minimal or no warning symptoms

  • extremely variable blood glucose levels

Some common things that may mean islet transplantation is not possible:

  • weight greater than 90 kg, or BMI greater than 30 kg/m2

  • insulin use greater than 0.9 units/kg/day

  • creatinine above 200 µmol/L

Does applying to the Clinical Islet Program mean I am committed to transplantation?

Application is an expression of interest only.

Is islet transplantation a cure for diabetes?

Islet transplantation is not a cure for diabetes but is an individual decision. An improved quality of life is the goal but this must be weighed with burden of care and responsibility to the program and self.

Is relocation to Edmonton necessary?

Patients are not required to relocate permanently to Edmonton. However, patients who undergo transplantation are expected to remain in Edmonton for at least 1 month following transplant for close follow-up monitoring.

Does the Clinical Islet Program accept international applicants?

Organ donation is limited in Canada and therefore we can only consider Canadian residents at the present time. International inquiries regarding islet transplant programs outside of Canada should be directed to: Clinical Islet Transplantation Consortium @ www.citisletstudy.org/ and/or Juvenile Diabetes Research Foundation International @ www.jdrf.org/.

What are the financial costs of islet transplantation?

Although there is no cost for the procedure, patients are responsible for travel associated with transplant and maintenance appointments and the costs of drug therapy. A social worker is available for consultation if finances are of concern.

Does the Clinical Islet Program accept pediatric applications?

We do not transplant children as the function of transplanted islets tends to decrease over time and the risks of lifelong immune suppression outweigh the demonstrated benefits of islet transplants in children.

Does the Clinical Islet Program perform living donor islet transplantation?

The Clinical Islet Transplant does not have an active program established in Edmonton. There are risks to donors that must be considered: operative mortality, risk of development of diabetes in the donor, risk of insufficient yield of islets following isolation procedure.

Can I donate my pancreas to someone with diabetes?

Directed donation may be difficult logistically and may be against the policy of most organ procurement organizations. However, individuals considering donation should complete their donor cards and discuss their wishes with next of kin.

How soon can I receive a transplant?

Following receipt of an application, patients undergo a comprehensive pre-transplant assessment if deemed eligible. The timeline between applying and active listing is approximately 3 months. Transplant wait times average 6 months but are dependant on weight, blood type, and organ availability.

Is the Clinical Islet Program involved with embryonic stem cell research?

Embryonic stem cell research is in the preliminary stages. The Clinical Islet Program does not have any immediate plans to follow this approach but may participate in clinical trials as they become available. The medical team attempts to keep abreast of the literature and communicate with other investigators. For further information about embryonic stem cell research, visit the Novocell website @ www.novocell.com/.

What is the role of cord blood in the treatment of diabetes?

Although cord blood stem cell transplant is becoming increasingly promising, the Clinical Islet Program is not currently involved with cord blood as a treatment for diabetes. The Program supports families persuing banking cord blood and/or donation amongst siblings. Gainesville is leading the cord blood trials: http://clinicaltrials.gov/ct2/show/NCT00305344.

Why are islets transplanted into the liver?

Infusion of islet into the liver may permit delivery of insulin directly to the liver – the key site of action. The liver is readily accessible as the vessels leading to the liver consist of a relatively low pressure system and animal models demonstrate good success. In addition, the concentration of orally administered immunosuppressant drugs in the liver is significantly higher than in the systemic circulation, potentially leading to lower dosage requirements.

Why are islets not transplanted into the pancreas?

The pancreas is much less accessible than the liver due to high pressures within the vessels leading to the pancreas. In addition, the risk of pancreatitis is much higher. Alternate sites are an active interest of the transplant world.

What is the current immune suppression protocol used?

The most common combination used is tacrolimus (Prograf®) and mycophenolate mofetil (Cellcept®) as these agents are much better tolerated than the original Edmonton protocol. Induction protocols vary. Choices are tailored to the individual. At any time, we may have clinical trials underway to assist researchers with determining whether new or existing therapies provide benefit to Clinical Islet Transplant patients. Patients must be consented for enrollment in clinical trials and only those meeting the inclusion criteria will be approached. Working towards a protocol that doesn't need lifelong immunosuppression is an important goal for all of us in the field.

What are the side effects of immune suppression?

Our current protocol is much better tolerated than the original Edmonton protocol. The most frequently reported side effects include headaches, tremor and gastrointestinal complaints. Immune suppression also increases susceptibility to other infections (bacterial, viral, fungal), some types of malignancies and can lead to kidney dysfunction.

What proportion of patients does not require insulin after islet transplantation?

1/3 of patients are off insulin. Average duration is 2.5 - 3 years but can be up to 11 years.

More than 75% have evidence of a functioning transplant beyond 5 years leading to stable glucose values and no hypoglycemia.

More detailed information can be found in this article

Is family planning post-islet transplantation a possibility?

At this time, family planning is not recommended post-islet transplantation. Individuals wishing to start/complete a family are asked to defer transplantation until family planning is not longer desired.

What options exist for the treatment of new onset Type 1 Diabetes?

The focus of diabetes treatments and research involves targeting immune responses and beta cell regeneration. For further information on clinical trials, visit Trialnet @ www.diabetestrialnet.org/index.htm and/or the Juvenile Diabetes Research Foundation website @ www.jdrf.org/.

Where can I find more information on diabetes research?

The following websites provide information and ongoing trials:

Juvenile Diabetes Research Foundation website @ http://www.jdrf.org/

Canadian Diabetes Association website @ http://www.diabetes.ca

Trialnet website @ www.diabetestrialnet.org/index.htm