Issues in clinical islet transplantation.

The Second International Islet Transplantation Symposium was held at UCLA in January, 1993. The symposium, sponsored by the Jerry's Foundation for Diabetes Research was focused on the issues in clinical islet transplantation. The leaders from each of the clinically active programs around the world were invited to discuss their clinical results and ways to achieve higher success rates. The Islet Transplantation Registry revealed there have been 178 islet transplants in human subjects worldwide: 11% of the patients have achieved insulin-independence; however, 20% of the patients have achieved insulin-independence during 1990-1992; 20% of the patients have functioning islet grafts as determined by circulating C-peptide levels; however 65% have functioning grafts during 1990-1992. These patients still require exogenous insulin; however, many demonstrate improved glucose control and decreased insulin requirements, and are considered to have a partially successful transplant. The major issues for clinical success are islet preparation, donor islet number, and prevention of rejection. We are hopeful that islet transplantation will realize its full potential this decade and await the advance in technology that will result in clinical success rates approaching that of solid organ transplantation.