Choosing the right path for islet cell replacement 

In EASD e-Learning’s latest module, which launches today, Professor Eelco de Koning examines the different patient journeys for islet transplantation that are available to people with diabetes, according to which transplantation technique best suits their condition.

Karim, a 58-year-old man with long-standing type 1 diabetes, rising blood pressure and signs of rapidly declining kidney function, attends your clinic. Despite his use of technology and the education and support he receives from his local diabetes team, he has recently been experiencing distressing hypoglycaemic events. While attending a local diabetes peer-support programme, he has heard about various therapeutic options, including developments in the field of transplantation, and would like to discuss these with you. As your discussions progress, he asks specifically whether an islet or pancreas transplant would be best for him and what would be the advantages and disadvantages of both options. How would you advise him?

Such scenarios are at the heart of the new module from Professor Eelco de Koning, ‘Patient journeys in islet transplantation’. Karim’s will be a familiar presentation for many healthcare professionals working in the field of type 1 diabetes. Yet those responsible for referring people with diabetes for transplantation often lack knowledge of islet and pancreas transplantation. According to Professor de Koning, only 25% of endocrinologists and nephrologists in the Netherlands have been exposed to the ins and outs of donor pancreas and/or islet transplantation.

Professor de Koning’s new module addresses that shortfall head on with a detailed examination of the contraindications and prerequisites for certain procedures, including simultaneous pancreas/kidney transplantation, kidney transplantation alone followed by pancreas/islet transplantation, solitary pancreas or islet transplantation, or more advanced technical support and no transplantation. 

The module combines an introduction to the practicalities of these options with a general call for better integration of pancreas and islet transplantation centres with expert diabetes centres to enable optimal decision making and streamlining of referrals. 

Learning outcomes

On completing this module you should be able to:
 

• Explain the range of transplantation techniques available to treat a subgroup of people with diabetes and severe beta cell failure and the goals and outcomes of each technique
• Examine the advantages and disadvantages of each available transplantation option and the factors diabetologists and nephrologists should consider when referring patients to specialist transplantation centres
• Plan the review and referral of typical patients with diabetes and severe beta cell failure to specialist transplantation centres, highlighting the importance of shared decision making to support patients to balance the risks and benefits of transplantation when making treatment decisions

For Professor de Koning’s module ‘Patient journeys in islet transplantation’, enrol on our course Islet transplantation.

Any opinions expressed in this article are the responsibility of the EASD e-Learning Programme Director, Dr Eleanor D Kennedy.