Curr Infect Dis Rep (2015) 17:25 DOI 10.1007/s11908-015-0482-9

TRANSPLANT AND ONCOLOGY (M ISON AND N THEODOROPOULOS, SECTION EDITORS)

Infectious Complications of Pancreatic Islet Transplantation: Clinical Experience and Unanswered Questions Stephanie M. Pouch

# Springer Science+Business Media New York 2015

Abstract Pancreatic islet transplantation is an evolving treatment modality for type I diabetes mellitus. While the field has advanced significantly over the course of the past three decades, our understanding of the infectious complications of pancreatic islet transplantation remains quite limited. This review aims to describe the current literature relating to infectious complications of pancreatic islet transplantation, including the role of microbiologically contaminated islet preparations in disease pathogenesis, our current understanding of the epidemiology and outcomes of cytomegalovirus and other infectious complications of pancreatic islet transplantation, and infectious concerns related to the use of porcine pancreatic islet cell xenografts. This review also highlights unanswered clinical questions and suggests areas of future research to mitigate infectious complications in recipients of islet transplantation. Keywords Pancreatic islet transplantation . Infection . Microbial contamination . Cytomegalovirus (CMV) . Xenotransplantation

Introduction The incidence of type I diabetes mellitus (DM) continues to increase globally [1–3]. While intensive insulin therapy reduces the risk of nephropathy and retinopathy and decreases cardiovascular events [4], glycemic control with medical This article is part of the Topical Collection on Transplant and Oncology S. M. Pouch (*) Transplant Infectious Diseases Service, Division of Infectious Diseases, Ohio State University Wexner Medical Center, 410 W. 10th Avenue, N1123 Doan Hall, Columbus, OH 43210, USA e-mail: [email protected]

therapy alone remains difficult for many patients. Over the past several decades, whole pancreas transplantation has proven effective in restoring normoglycemia in those with DM, but carries with it the inherent risks of intra-abdominal surgery and management of pancreatic exocrine secretions [5]. Efforts to achieve insulin independence in a less invasive manner and by utilizing only the endocrine components of the pancreas led to the advent of pancreatic islet transplantation. The first pancreatic islet transplant was performed with concomitant use of azathioprine and corticosteroids in 1977 [6]. Through 1999, however,

Infectious complications of pancreatic islet transplantation: clinical experience and unanswered questions.

Pancreatic islet transplantation is an evolving treatment modality for type I diabetes mellitus. While the field has advanced significantly over the c...
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