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Emory islet cell transplant patients celebrate 10 years of being diabetes free

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Janet Christenbury

It's been 10 years since two Emory patients entered into a clinical trial for their Type 1 diabetes and experienced exceptional outcomes. Today, the Emory Transplant Center celebrated their 10-year anniversary of being diabetes-free, thanks to a unique transplant of donor pancreatic islet cells.

Pancreatic islet cells are tiny clusters of cells scattered throughout the pancreas that produce the hormone, insulin. In patients who have Type 1 diabetes, which is an autoimmune disease, the pancreas stops producing insulin, a hormone that enables people to get energy from food. Therefore, Type 1 diabetics must take insulin every day to live.

Both Rob Allen and Laura Cochran have struggled with diabetic highs and lows for years. Allen was diagnosed with Type 1 diabetes at age 17, after severe weight loss, extreme fatigue and an unquenchable thirst. He was able to manage the diabetes with insulin injections for about 10 years until he began having frequent and more serious diabetic episodes involving low blood sugar. An insulin pump helped some, then he heard about the islet cell transplant clinical trial at Emory.

Cochran was diagnosed with Type 1 diabetes at age 27. She soon developed hypoglycemia unawareness, where her blood sugar would drop so low so quickly, that she didn't recognizing how low her sugars were. These episodes often left Cochran confused and dazed.

"As a mother of four, I had several severe hypoglycemia incidents while with my children, and that was scary," says Cochran, who lives in Columbus, Ga. She was placed on an insulin pump, but still needed more relief.

Emory Transplant Center doctors and patients

Dr. Nicole Turgeon, Emory kidney/pancreas transplant surgeon; Rob Allen, islet cell transplant recipient; Laura Cochran, islet cell transplant recipient; Dr. Christian Larsen, Emory kidney/pancreas transplant surgeon (from left to right)

Both Allen and Cochran were candidates for a clinical trial at Emory where donor pancreatic islet cells were transplanted to restore insulin production in people with Type 1 diabetes.

"Through a small incision in the abdomen, we placed an IV into the vein going to the liver," says Christian Larsen, MD, DPhil, professor of surgery in the Division of Transplantation at Emory, and dean of Emory University School of Medicine. "Then using a slow-drip method, we infused hundreds of thousands of donor islet cells into the patient. Those islets made their way from the liver to the pancreas to restore insulin production."

Allen and Cochran both received two islet cell transplants from two different organ donors, several months apart. After one transplant, they both still needed small amounts of insulin injections. But after the second transplant, they no longer needed daily injections. And they both have been insulin free since 2004.

"We transplanted just two teaspoons of islet cells into these patients 10 years ago, and they no longer need insulin injections," says Larsen, who is a kidney and pancreas transplant surgeon. "This has been a miraculous transformation."

"The best part about the islet cell transplants is not having to worry daily about my blood glucose levels getting out of control," says Allen, a Lilburn resident. "It has been an amazing thing."

A total of 19 patients have received islet cell transplants in four different clinical trials at Emory. Researchers are awaiting FDA approval of islet cell transplants so the surgery will no longer be experimental. At that point, surgeons can perform these transplants on patients who meet criteria.

Like with all organ transplants, recipients, including islet cell recipients, must take anti-rejection medications the rest of their life.

Larsen, the former executive director of the Emory Transplant Center, together, with long time collaborator Thomas Pearson, MD, DPhil, played a pivotal role in developing a new class of immunosuppressive drugs to replace the cyclosporine class of drugs and their major side effects and toxicities. The FDA approved the co-stimulation blocker called belatacept in June 2011 for kidney transplant recipients. This was the first time a new class of drug had been approved for transplant since the 1990s.

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