On January 19, at Kyoto University Hospital, Dr. Koichi Tanaka and Dr. James Shapiro, along with a team of Japanese surgeons, removed part of a 56-year-old woman's pancreas. Dr. Shinichi Masumoto then isolated the living islets in the Kyoto Centre for Cell and Molecular Therapy. Under Dr. Shapiro's supervision, the team then transplanted the insulin-producing cells into the woman's 27-year-old diabetic daughter.
The transplanted islets began producing insulin within minutes, explains Dr. Shapiro. "The reason I'm so excited about this is because normally the Edmonton Protocol is done with islets from brain-dead organ donors. Those islets are often severely injured from cold storage, transport time and the pancreas is severely damaged by toxins which circulate in the blood stream after brain death."
"Our expectation is that these islets from near-perfect organs will work better, although it's too early to tell," he says.
The recipients use the same drugs to prevent organ rejection as are used in the Edmonton Protocol.
Dr. Shapiro was invited to participate in the operation in Kyoto, Japan, where he originally did living donor liver transplant training with Dr. Tanaka. Dr. Masumoto was previously based in Seattle and had been involved in Dr. Shapiro's international trial of the Edmonton Protocol before returning to Japan. Dr. Shapiro first suggested the idea of starting a living donor islet transplant program in Kyoto while lecturing there three years ago. Cadaveric organ donors are scarce in Japan, and living donation has very established roots in liver and kidney transplantation there.
"Living donor islet transplants could allow many more desperate patients with type 1 diabetes to get successful islet transplants, " says Dr. Shapiro. "The donor operation is relatively safe, but is not entirely devoid of serious potential risk," he added.
A shortage of donor islet cells is the biggest obstacle preventing implementation for all patients who need it, Shapiro added.
The mother of the diabetic daughter was in perfect health, while her daughter has been on the cadaver donors transplant list since September 2004. Before the surgery, the woman had been subject to severe low blood sugar coma attacks, and her glucose control has been transformed by the transplant.
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