Pancreatic Islet Transplantation for Type 1 Diabetes: Who Qualifies, What to Expect, and a Comprehensive List of U.S. Centers Offering the Procedure

Key Takeaways:

Islet transplantation helps stabilize blood sugar in type 1 diabetes patients with severe hypoglycemia unawareness.
Only select patients qualify, and recipients must take lifelong immunosuppressants.
Around 50% achieve insulin independence at 1 year, but long-term success varies.
The procedure is available at 20+ U.S. centers, though access and insurance coverage remain limited.

Pancreatic islet transplantation is an innovative therapy for individuals with type 1 diabetes (T1D) who experience severe hypoglycemia unawareness, a condition where patients cannot detect dangerously low blood sugar levels. This procedure involves transplanting insulin-producing islet cells from a deceased donor’s pancreas into the recipient’s liver via the portal vein. While not a cure, it aims to stabilize blood glucose levels, reduce insulin dependence, and mitigate diabetes-related complications. This guide examines the procedure’s history, benefits, risks, eligibility, U.S. transplant centers, and critical considerations for prospective patients.

Islet Transplantation, Credit: PLoS Medicine, 1(5), e58

Understanding Pancreatic Islet Transplantation

In T1D, the immune system destroys insulin-producing beta cells in the pancreatic islets. Islet transplantation replaces these cells with donor islets, which engraft in the liver and restore insulin production. The procedure is minimally invasive but often requires multiple donor pancreases to obtain sufficient islets. Recipients must take lifelong immunosuppressive drugs to prevent rejection (Shapiro et al., 2021).

Who Qualifies for Islet Transplantation?

Most patients considered for islet transplantation have:

Type 1 diabetes with severe hypoglycemia unawareness
Unstable glucose control despite advanced insulin therapy (e.g., pumps or closed-loop systems)
No contraindications to lifelong immunosuppression (e.g., active infection, certain cancers, liver disease)

Historical Milestones

1970s–1990s: Early attempts failed due to inadequate islet isolation and toxic immunosuppression (Witkowski et al., 2025).
2000: The Edmonton Protocol introduced steroid-free immunosuppression (sirolimus, tacrolimus) and multi-donor transplants, achieving insulin independence in 80% of patients (Shapiro et al., 2000).
2023: The FDA approved Donislecel (Lantidra), the first islet cell therapy, though regulatory barriers limited access (Knoll et al., 2021).
2025: Research focuses on stem cell-derived islets (Vertex’s VX-880) and xenotransplantation to address donor shortages (Frontiers in Immunology, 2024).

Benefits

Glycemic Stability: 87% of recipients achieve HbA1c <7% and avoid severe hypoglycemia for 1 year (Collaborative Islet Transplant Registry [CITR], 2023).
Reduced Insulin Dependence: ~50% achieve insulin independence at 1 year (NIDDK, 2024).
Complication Prevention: Slows retinopathy, nephropathy, and neuropathy progression (Shapiro et al., 2021).
Extended Benefits: Some recipients maintain partial insulin independence or improved glucose awareness years after transplantation. However, only 25–30% remain fully insulin-independent at 3 years (CITR, 2023).

Risks

Surgical Complications: Bleeding (8%), portal vein thrombosis, and infections (UCSF Surgery, 2023).
Immunosuppression: Increased risk of infection, kidney damage, and malignancy (NHS Blood and Transplant, 2019).
Graft Failure: ~60% of transplanted islets are lost within 1 year due to immune rejection or insufficient engraftment (Frontiers in Immunology, 2024).

U.S. Transplant Centers

The following centers offer islet transplantation in the US:

University of California, San Francisco (UCSF)
Contact: UCSF Transplant Center | Phone: (415) 353-8893

Website: ucsfhealth.org

City of Hope (Duarte, CA)
Contact: City of Hope | Phone: 866-44-ISLET (47538)
cityofhope.org

University of Nebraska
Contact: University of Nebraska Transplant Program | Phone: (800) 401-4444

Website: nebraskamed.com

University of Minnesota Medical Center (Minneapolis, MN)
Contact: U of M Islet Transplant Clinic| Phone: (855) 324-7843

Website: mhealthfairview.org

University of Wisconsin (Madison, WI)
Contact: UW Health Transplant Center|Phone: (608) 263-9531

Website: uwhealth.org

University of Illinois, Chicago (Chicago, IL)
Contact: UI Health Transplant Program| Phone: (866) 600-CARE
hospital.uillinois.edu

Northwestern University (Chicago, IL)
Contact: Northwestern University Medicine| Phone: (844) 344-6663

Website: nm.org

University of Chicago (Chicago, IL)
Contact: University of Chicago Medicine | Phone: (773) 702-1000

Website: uchicagomedicine.org

Ohio State University (Columbus, OH)
Contact: OSU Wexner Medical Center| Phone: (614) 293-6255

Website: wexnermedical.osu.edu/

University of Louisville (Louisville, KY)
Contact: UofL Health Transplant Center| Phone: 502-852-5237

Website: louisville.edu

Emory Transplant Center (Atlanta, GA)
Contact: Emory Healthcare | Phone: (404) 778-7777

Website: emoryhealthcare.org

Baylor, Scott & White Health (Dallas, TX)
Contact: Baylor Transplant Institute | Phone: (844) 279-3627

Website: bswhealth.com

Medical University of South Carolina (Charleston, SC)
Contact: Medical University of South Carolina| Phone: (843) 792-6982

Website: muschealth.org

University of Miami (Coral Gables, FL)
Contact: DeWitt Daughtry Family Department of Surgery| Phone: (305) 243-2424

Website: miami.edu

University of Pennsylvania (Philadelphia, PA)
Contact: Penn Medicine Transplant Institute| (800) Phone: 789-7366

Website: pennmedicine.org

University of Pittsburgh (Pittsburgh, PA)
Contact: UPMC Transplant Services| Phone: (412) 647-8762

Website: upmc.com

University of Virginia (Charlottesville, VA)
Contact: UVA Health| Phone: (434) 924-8604

Website: uvahealth.com

Virginia Commonwealth University (Richmond, VA)
Contact: Hume-Lee Transplant Center| Phone: (804) 828-4104

Website: vcuhealth.org

Georgetown University (Washington, DC)
Contact: MedStar Health|Phone: (877) 772-6505

Website: medstarhealth.org

Columbia University (New York, NY)
Contact: Columbia Surgery| Phone: (212) 305-9467

Website: columbiasurgery.org

Massachusetts General Hospital (Boston, MA)
Contact: Massachusetts General Hospital Transplant Center|Phone: (877)644-2860

Website: massgeneral.org

Critical Considerations

Pros vs. Cons

Pros: Eliminates life-threatening hypoglycemia, reduces complications, and offers hope for future therapies (NIDDK, 2024).
Cons: Requires lifelong immunosuppression, costs over $100,000, and remains inaccessible to many (Knoll et al., 2021).

Insurance & Costs

Medicare and most private insurers do not cover standalone islet transplantation.
Coverage may be possible if paired with a kidney transplant (CITR, 2023).

Total costs for standalone islet transplantation often exceed $100,000, not including lifelong immunosuppressive therapy and post-transplant monitoring.

Alternatives

Closed-loop insulin pumps are effective for patients with stable glucose patterns (NIDDK, 2024).
Stem cell trials (e.g., VX-880) show promise for future insulin independence.

Ethical Concerns

Donor islets are classified as “drugs” in the U.S., sparking debate over commercialization and equitable access.

FAQs

What is pancreatic islet transplantation?
A procedure that transfers insulin-producing cells into the liver to help regulate blood sugar.

Who is eligible?
Adults with type 1 diabetes and frequent severe hypoglycemia despite advanced insulin therapy.

Is it a cure for diabetes?
No. It may reduce or eliminate insulin use temporarily, but it’s not permanent or guaranteed.

How long do the benefits last?
Most patients see improved control for 1–3 years. Full insulin independence beyond that is rare.

What are the main risks?
Rejection of the cells, side effects from immunosuppressants, and potential surgical complications.

Do recipients still need insulin?
About 50% don’t need insulin after one year, but most eventually return to at least partial use.

Is it available outside of research studies?
Only at select centers, often when combined with kidney transplantation.

Is it FDA-approved?
Yes—Donislecel (Lantidra) was approved in 2023, but access remains limited.

Does insurance cover it?
Rarely, unless part of a combined organ transplant. Coverage varies widely.

Can children get islet transplants?
Pediatric cases are extremely limited and usually only within research settings.

What’s the cost?
Upwards of $100,000, not including ongoing care.

Are there alternatives?
Closed-loop insulin pumps and stem cell trials (like VX-880) offer promising options.

What’s new in research?
Stem-cell islets, islet encapsulation (to avoid immunosuppression), and pig islet (xeno) transplants.

Why is access so limited?
Islets are regulated as drugs in the U.S., making the process complex and costly.

How long do the benefits of islet transplantation last?
Many patients experience improved glucose control for 1–3 years. Some retain partial insulin function longer.

Is it available outside of clinical trials?
Yes, but only in select centers and usually alongside kidney transplants.

Can islet transplantation delay diabetes complications long-term?
Possibly. Some studies suggest slower progression of neuropathy and retinopathy in transplant recipients.

What’s the difference between auto-islet and donor-islet transplantation?
Auto-islets come from your own pancreas during surgery for chronic pancreatitis; no immunosuppression is needed.

Final Recommendation: Is It Right for You?

Pancreatic islet transplantation remains a highly specialized option — not a first-line therapy, but a potential lifesaving intervention for patients with unmanageable type 1 diabetes. If you’ve experienced repeated episodes of severe hypoglycemia despite using insulin pumps, continuous glucose monitors, or hybrid closed-loop systems, and no longer recognize when your blood sugar drops, this therapy could be life-changing.

However, the decision isn’t simple.

Immunosuppression trade-offs: You’ll need to commit to lifelong immunosuppressive medications, which carry risks like kidney damage, infections, and increased cancer risk. That’s a serious consideration if your glucose is otherwise controllable through technology.
Long-term outcomes: While many patients see improved glucose control and fewer complications, full insulin independence rarely lasts beyond 2–3 years. The goal is often safety and stability, not a total cure.
Access and affordability: In the U.S., regulatory hurdles and lack of insurance coverage mean the procedure is not widely accessible. You may need to enroll in a clinical trial or travel to a major academic transplant center.

If you’re exploring this path, ask your endocrinologist or diabetes care team:

Am I a candidate for islet transplantation or a related clinical trial?
Do I qualify for coverage if combined with a kidney transplant?
Are my hypoglycemia episodes severe enough to justify the risks?

For many, participating in a trial involving stem cell–derived islets (like Vertex’s VX-880) or encapsulation technology may offer similar benefits with fewer drawbacks.

In short, islet transplantation is not for everyone, but for the right patient, it can offer freedom, safety, and new possibilities in managing a difficult disease. The future of diabetes care may lie in therapies like this, especially as science moves closer to bioengineered and universal donor islets.

References

Wang, Q., Huang, Y.-x., Liu, L., Zhao, X.-h., Sun, Y., Mao, X., & Li, S.-w. (2024). Pancreatic islet transplantation: Current advances and challenges. Frontiers in Immunology, 15, Article 1391504. https://doi.org/10.3389/fimmu.2024.1391504

Shapiro, A. M. J., Lakey, J. R. T., Ryan, E. A., Korbutt, G. S., Toth, E., Warnock, G. L., Kneteman, N. M., & Rajotte, R. V. (2000). Islet transplantation in seven patients with type 1 diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. New England Journal of Medicine, 343(4), 230–238. https://doi.org/10.1056/nejm200007273430401

Naftanel, M. A., & Harlan, D. M. (2004). Pancreatic islet transplantation. PLoS Medicine, 1(5), e58. https://doi.org/10.1371/journal.pmed.0010058

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