Edmonton protocol
You don't need to be Editor-In-Chief to add or edit content to WikiDoc. You can begin to add to or edit text on this WikiDoc page by clicking on the edit button at the top of this page. Next enter or edit the information that you would like to appear here. Once you are done editing, scroll down and click the Save page button at the bottom of the page.
|
WikiDoc Resources for Edmonton protocol | |
|
Articles | |
|---|---|
|
Most recent articles on Edmonton protocol Most cited articles on Edmonton protocol | |
|
Media | |
|
Powerpoint slides on Edmonton protocol | |
|
Evidence Based Medicine | |
|
Cochrane Collaboration on Edmonton protocol | |
|
Clinical Trials | |
|
Ongoing Trials on Edmonton protocol at Clinical Trials.gov Trial results on Edmonton protocol Clinical Trials on Edmonton protocol at Google
| |
|
Guidelines / Policies / Govt | |
|
US National Guidelines Clearinghouse on Edmonton protocol NICE Guidance on Edmonton protocol
| |
|
Books | |
|
News | |
|
Commentary | |
|
Definitions | |
|
Patient Resources / Community | |
|
Patient resources on Edmonton protocol Discussion groups on Edmonton protocol Patient Handouts on Edmonton protocol Directions to Hospitals Treating Edmonton protocol Risk calculators and risk factors for Edmonton protocol
| |
|
Healthcare Provider Resources | |
|
Causes & Risk Factors for Edmonton protocol | |
|
Continuing Medical Education (CME) | |
|
International | |
|
| |
|
Businness | |
|
Experimental / Informatics | |
Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [1] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
The Edmonton Protocol is a method of implantation of pancreatic islets for the treatment of type 1 diabetes mellitus, specifically "brittle" type 1 diabetics prone to hypoglycemic unawareness. The protocol is named for the islet transplantation group at the University of Alberta in the Canadian city of Edmonton, where the protocol was first devised in the late 1990s.
Procedure
The Edmonton Protocol involves isolating islets from a cadaveric donor pancreas using a mixture of enzymes called Liberase™ (Roche). Each recipient receives islets from one to as many as three donors. The islets are infused into the patient's portal vein, and are then kept from being destroyed by the recipient's immune system through the use of two immunosuppressants, sirolimus and tacrolimus as well as a monoclonal antibody drug used in transplant patients called daclizumab.
History
Islet isolation and transplantation was pioneered by Paul Lacy throughout the 1960s. He and Walter Ballinger together were able to restore normoglycaemia in diabetic rats following the transplantation of isolated islets into the rodent's livers. Scientists have not yet successfully translated Dr. Lacy's success in rodents to humans.
The Edmonton Protocol was primarily developed by Dr James Shapiro (transplant surgeon), Jonathan Lakey Ph.D., Dr Edmond Ryan (endocrinologist), Gregory Korbutt Ph.D., Dr. Ellen Toth, Dr. Garth Warnock, Dr. Norman Kneteman, and Ray Rajotte Ph.D., at the University of Alberta Hospital and the Surgical-Medical Research Institute. The first patient was treated using the Edmonton Protocol in March 1999. The protocol was first published in the New England Journal of Medicine in July 2000.
The NEJM report was exciting for the diabetes field because all seven patients undergoing the Edmonton Protocol remained insulin-independent after an average of 12 months.
Current review
It has recently been reported that of thirty-six patients transplanted, only sixteen (44%) were insulin-independent after one year; ten (28%) had partial graft function after one year; and ten (28%) had complete graft loss after one year. Insulin independence is not usually sustainable in the long term, but the transplanted islets still function enough to provide protection from severe hypoglycemic episodes and unawareness.
The major problem limiting islet transplantation therapy for type 1 diabetic individuals is the lack of organ donors.
References
- [2] Shapiro AMJ, Lakey JRT, Ryan EA, Korbutt GS, Toth E, Warnock GL, Kneteman NM, Rajotte RV. Islet transplantation in seven patients with type 1 diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. N Engl J Med. 2000;343:230-238.
- [3] Saffitz JE, Schmidt RE, McDaniel ML. Dr. Paul Eston Lacy, 1924–2005. American Journal of Pathology. 2005;167:299-300.
- [4] Ryan EA, Paty BW, Senior PA, Bigam D, Alfadhli E, Kneteman NM, Lakey JR, Shapiro AM. Five-year follow-up after clinical islet transplantation. Diabetes. 2005 Jul;54(7):2060-9.
- [5] Sutherland DE, Gruessner RW, Gruessner AC. Pancreas transplantation for treatment of diabetes mellitus. World J Surg. 2001 Apr;25(4):487-96.
- [6] Shapiro AMJ, Ricordi C, Hering BJ et al. International trial of the Edmonton protocol for islet transplantation. N Engl J Med. 2006;355:1318-1330.
- [7] O'Gorman D, Kin T, Murdoch T, Richer B, McGhee-Wilson D, Ryan EA, Shapiro AMJ, Lakey JRT. The standardization of pancreatic donors for islet isolations. Transplantation. 2005 Sep;80(6):801-806.
External links
Organ transplantation | |
|---|---|
| Types | Allograft · Alloplant · Allotransplantation · Autotransplantation · Xenotransplantation |
| Organs and tissues | Bone · Bone marrow · Corneal · Face · Hand · Heart · Heart-lung · Kidney · Liver · Lung · Pancreas · Penis · Skin · Spleen · Uterus |
| Related topics | Biomedical tissue · Cellular memory · Edmonton protocol · Eye bank · Graft-versus-host disease · Immunosuppressive drugs · Islet cell transplantation · Implants · Living donor liver transplantation · Lung allocation score · Machine perfusion · Medical grafting · Non-heart beating donation · Organ donation · Post-transplant lymphoproliferative disorder · Repugnant market · Total body irradiation · Transplant rejection |
| Organizations | Halachic Organ Donor Society · Human Tissue Authority · National Marrow Donor Program · United Network for Organ Sharing |
| People | Christiaan Barnard · Michael Woodruff · Alexis Carrel · Norman Shumway · Jean-Michel Dubernard · List of notable organ transplant donors and recipients |
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
