The ultimate goal to provide a cure for all patients suffering from type-1-diabetes has remained out of the patients reach despite major advances in technologies. There has however, for a number of decades been a concerted effort to use various forms of porcine β-cells as a replacement transplant alternative to cadaveric human donors. This has seen major advances in the last decade with significant development of multi-transgenic donor pigs that now can potentially be used for xenotransplantation. This has been achieved with cellular transplants leading the way using porcine islet cell transplants as a form of β cell replacement in pre-clinical studies to treat diabetic non-human primates in various guises. These uniquely modified islet cells have the potential to offer an unlimited source of insulin-producing cells once we have solved all of the issues required to prevent loss of the xenotransplant. This chapter provides an in depth overview as to how the most recent advances have been achieved in regards to the genetic modification of donor pigs to provide protection from hyperacute rejection, instant blood mediated inflammatory reaction, xenoantibody and cellular responses to provide long-term functional islet cell xenotransplants to be able to move islet cell xenotransplantation to the clinic.
Part of the book: Xenotransplantation
For more than five decades, we have been refining advances in pancreas whole organ and islet cell transplantation as clinical therapies to treat the ever-increasing number of patients suffering from type-1-diabetes. Research and clinical practice have contributed to making both whole organ and cellular transplantation viable therapeutic options for a broader range of patients. Furthermore, both forms of clinical transplantation results have progressively improved, due to the ongoing refinement of organ donation and its various technical processes, combined with the evolution of immunosuppression and patient care now offering excellent long-term treatment for both type-1-diabetes and concomitant renal failure. This chapter provides an overview on how this has been undertaken and achieved over decades to ultimately provide outstanding outcomes on par with other organ transplantation results. Briefly, we cover the history of pancreas retrieval procedures, the importance of donor selection, the intricate processes of the organ donor operation, preservation of the pancreas, and the ideal ways to best improve outcomes for transplantation. Improving and providing the optimal donor and preservation conditions underpinning the success of subsequent whole pancreas or islet transplantation as a safe, effective, and feasible therapeutic option for an increasing number of patients suffering from type-1-diabetes.
Part of the book: Organ Donation and Transplantation