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The UK islet allotransplant program is nationally funded to deliver one or two transplants over 12 months to individuals with type 1 diabetes and recurrent severe hypoglycemia. Analyses were undertaken 10 years after program inception to evaluate associations between transplanted mass; single versus two transplants; time between two transplants and graft survival (stimulated C-peptide >50 pmol/L) and function. In total, 84 islet transplant recipients were studied. Uninterrupted graft survival over 12 months was attained in 23 (68%) single and 47 (94%) (p = .002) two transplant recipients (separated by [median (IQR)] 6 (3–8) months). 64% recipients of one or two transplants with uninterrupted function at 12 months sustained graft function at 6 years. Total transplanted mass was associated with Mixed Meal Tolerance Test stimulated C-peptide at 12 months (p < .01). Despite 1.9-fold greater transplanted mass in recipients of two versus one islet infusion (12 218 [9291–15 417] vs. 6442 [5156–7639] IEQ/kg; p < .0001), stimulated C-peptide was not significantly higher. Shorter time between transplants was associated with greater insulin dose reduction at 12 months (beta −0.35; p = .02). Graft survival over the first 12 months was greater in recipients of two versus one islet transplant in the UK program, although function at 1 and 6 years was comparable. Minimizing the interval between 2 islet infusions may maximize cumulative impact on graft function.

Despite major advances in structured education, insulin delivery and glucose monitoring, diabetes self-management remains an unremitting challenge. Insulin therapy is inextricably linked to risk of dangerous hypoglycaemia and sustained hyperglycaemia remains a leading cause of renal failure. This review sets out to demystify transplantation for diabetes multidisciplinary teams, facilitating consideration and incorporation within holistic overall person-centred management. Deceased and living donor kidney, whole pancreas and isolated islet transplant procedures, indications and potential benefits are described, in addition to outcomes within the integrated UK transplant programme.

Islet transplantation has been funded in the UK by the National Health Service since 2008. Pancreata are optimally procured by the National Organ Retrieval Service and shared equitably between islet and solid organ recipients. Islets are isolated at three central clean room facilities and transported to one of the seven geographically distributed multidisciplinary assessment, transplant, and follow-up centers. Recipients with life-threatening hypoglycemia despite optimized conventional therapy receive up to two sequential islet transplants with the goal of preventing further severe hypoglycemia and attaining optimal overall glycemic control. Over the first 10 years of the program, 243 islet transplants have been performed in 144 recipients. The majority of these (85%) have been islet transplants alone. Non-inferiority of transported versus locally isolated islets has been confirmed with 88% graft function at 1 year associated with median severe hypoglycemia rate of zero and HbA1c 6.8%. This has provided a sustainable platform for ongoing service provision and further innovation.