Immunosuppression for pancreatic islet transplantation

Transplant Proc. 2004 Mar;36(2 Suppl):362S-366S. doi: 10.1016/j.transproceed.2003.12.035.


Protocols for islet transplantation have to take into account the diabetogenicity/islet toxicity of the immunosuppressive agents, namely corticosteroids and calcineurin inhibitors, most notably tacrolimus. The development by the Edmonton group of a sirolimus-based, steroid-free, low-tacrolimus regimen was a significant breakthrough that allowed the rate of insulin independence after islet transplantation to increase from 13% to 80% at 1 year. Drawbacks include the side effects of sirolimus and the reduction in insulin independence to 50% at 3 years, the latter being attributed to prolonged tacrolimus exposure. Currently explored alternatives to tacrolimus include cyclosporine, mycophenolate mofetil, and the novel agent FTY 720. Perspectives for the near future involve the achievement of "prope tolerance" by strategies using lymphocyte-depleting antibodies (anti-thymocyte globulin, campath-1H, hOKT3gamma1 [ala,ala]), or costimulatory blockade (anti-CD154 mAbs, CTLA4-Ig).

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Cyclosporine / therapeutic use
  • Drug Therapy, Combination
  • Humans
  • Immunosuppression Therapy / adverse effects
  • Immunosuppression Therapy / methods
  • Immunosuppressive Agents / therapeutic use
  • Islets of Langerhans Transplantation / immunology*
  • Islets of Langerhans Transplantation / pathology
  • Lymphocyte Depletion
  • Sirolimus / therapeutic use


  • Immunosuppressive Agents
  • Cyclosporine
  • Sirolimus