Advances in clinical islet isolation

Currently, islet transplantation is continuing to emerge as a viable treatment strategy for selected patients with type 1 diabetes who suffer from severe hypoglycemia and glycemic instability. Subsequent to the initial report, in 2000 from Edmonton, of insulin independence in seven out of seven consecutive recipients, there has been an immense expansion in clinical islet transplantation in specialized centers worldwide. The challenge now is to avoid the observed islet graft attrition over time. Isolating high-quality human islets, which survive and function indefinitely, will undoubtedly contribute to the further improvements in long-term clinical outcome. This chapter outlines the criteria for selecting appropriate donors for islet isolation and transplantation, describes the processes involved in islet isolation, and discusses the scope for areas of further improvements.