On Friday 29 January, Ms. Sue York, from Lincoln, received a successful pancreas transplant because of a very severe needle phobia. For the foreseeable future, she will not need to inject insulin. Ms. York described the feeling as “incredible”.
This is amazing news. Ms. York’s procedure represents a massive breakthrough in the treatment of type 1 diabetes. Insulin injections, which used to leave her shaking and vomiting, are for now not a concern. But many people have mistaken the transplant for a cure, when in fact it isn’t one. Not quite.
The wonderful thing is that the procedure will allow Ms. York to produce her own insulin, but there’s more to curing type 1 diabetes than reviving insulin production. Even though Ms. York now has a fully-functioning pancreas, she still has the disease that prevented it from working before. To cure type 1 diabetes, it’s this fault with the immune system that needs to be fixed.
So, to maintain insulin production, Ms. York has to take immunosuppressant medication. Because her immune system will attack the cells that produce insulin, this medication is necessary to keep it at bay.
So how long is it likely to last? That depends. The best case to compare it to is that of Richard Lane, the first person in the UK to successfully receive an islet cell transplant. Like Ms. York, Mr. Lane had to take immunosuppressant drugs, and they allowed him to be insulin-injection free for over a year. This was back in 2005, and the BBC announced the news with the slightly misleading headline “Transplant cures man of diabetes.”
Like Ms. York, Mr. Lane had to take immunosuppressant drugs. This allowed him to live for five years without insulin. Unfortunately, Mr. Lane now has to inject again, but the progress he made was massively promising. Even now, he doesn’t have to inject as much as most people with type 1 diabetes, and certainly not as much as he had to before he received the islet cell transplant. It’s likely that we might see a similar story with Ms. York.
If the pancreas will probably stop working again, why all the fuss about the transplant? Why not just stick with islet cell transplantation? In short, it’s because transplanting an entire pancreas is far more effective than islet cell transplantation. As Vardanyan et al. write: “Although [pancreas transplantation] requires major surgery and life-long immunosuppression, it remains the gold standard for a specific population of patients who suffer from type 1 diabetes and who do not respond to conventional therapy. Allogeneic islet transplantation is a promising alternative to pancreas transplantation, but patient outcomes remain less than optimal and significant progress is required in order for this procedure to be considered a reliable therapy.”
In other words: in an ideal world, pancreas transplantation would be readily available for everyone. The procedure is, on the whole, far more convincing. Unfortunately, the process requires major surgery, and often many years on a waiting list for a suitable transplant to be available.
Even if pancreas transplants were widely available, they are still extremely risky. Potential side effects include blood clots, infection, urinary complications, and pancreatic failure. Then there are the side effects associated with immunosuppressant medication, such as bone thinning, high cholesterol and high blood pressure. It’s because of these many side effects that pancreatic transplants are reserved for very serious cases.
That said, it’s likely that over the years we’ll see huge improvements in the area of pancreas transplantation, and, as the process becomes easier and safer, it’s likely to become more widely available. The fact that Ms. York’s transplant was conducted because of a needle phobia shows that things are well in the way. It’s not quite a cure, but that doesn’t mean it’s not extremely exciting.