Article information
Abstract
Diabetes treatment with insulin does no prevent the development of secondary complications. For this reason, treatments other than conventional ones are needed, which could bring about an “almost physiological” metabolic regulation. This can only be done by transplanting insulin producing tissue, such as vascularised pancreas transplantation, which is an already consolidated clinical procedure these days, or by islets transplantation, which is still a procedure in the clinical research phase. This has the same metabolic objectives as the vascularised transplant, but without the risks of major abdominal surgery, since the islets are implanted in the liver with minimal surgery or using interventionist radiology by means of a catheter. A clinical trial (Edmonton Protocol) was published in the year 2000, which improved the results after islet transplantation by obtaining normoglycaemia periods of more than 1 year in a consecutive patient series with type 1 diabetes and without using corticoids. This protocol has been endorsed in other centre in different trials. Although the initial results were good, the progress of these patients has shown that many islets transplantations do not manage to maintain insulinindependence indefinitely.
Keywords:
Diabetes mellitus
Transplantation
Islet
Resumen
El tratamiento de la diabetes mellitus con insulina no evita la aparición de complicaciones. Por ello son necesarios tratamientos alternativos al convencional que permitan una regulación metabólica “casi fisioloógica”. Esto sólo puede realizarse mediante el trasplante de tejido productor de insulina: el trasplante de páncreas vascularizado, que hoy es un procedimiento clínico ya consolidado, o mediante el trasplante de islotes, que continúa siendo un procedimiento en fase de investigación clínica. Éste tiene los mismos objetivos metabólicos del trasplante vascularizado, pero sin los riesgos de una cirugía abdominal mayor, ya que los islotes son implantados en el hígado con mínima cirugía o mediante radiología intervencionista a través de un catéter. En 2000 se publicó un ensayo clínico (Protocolo de Edmonton) que mejoraba los resultados tras el trasplante insular obteniendo periodos de normoglucemia de más de 1 año en una serie consecutiva de pacientes con diabetes mellitus tipo 1 mediante un régimen sin corticoides. Ese protocolo ha sido refrendado en otros centros en diferentes ensayos. Aunque los resultados iniciales fueron buenos, la evolución de los pacientes a medio y largo plazo ha puesto de relieve que muchos de los islotes trasplantados no consiguen mantener por tiempo indefinido la independencia de la insulina
Palabras clave:
Diabetes mellitus
Trasplante
Islotes
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