Possible Complications

So far, there have been few complications reported as the result of islet transplantation, and the incidence of complications has actually decreased as experience has been gained in this procedure. However, there is limited worldwide experience in this new field. The possibility exists that an unexpected complication will arise as this area of research grows throughout the United States and the rest of the world. The following is a list of complications identified so far that may be related to the islet transplant procedure:

• Bleeding at the site of the catheter insertion. Excessive bleeding can require blood transfusions or in extreme cases, another open surgical procedure to stop the bleeding.
• Blood clot in the portal vein or liver. This can decrease the blood supply to the liver, which could lead to liver failure, liver transplant, and possibly death.
• Low blood glucose levels after the islet injection.
• Shoulder and abdominal pain. This usually resolves within 2-3 days.
• Infection

Rejection

Rejection occurs when the immune system recognizes the transplanted islets as foreign and attacks them. The immune system is the body’s natural defense against foreign invaders such as viruses, bacteria, and some types of cancers. To help prevent rejection of transplanted islets, immunosuppressant medications are taken, which weaken the immune system. These medications must be taken on time and as prescribed in order to reduce the risk of rejection. The immunosuppressants must be taken for as long as the islets are working. There is still a possibility that the body will reject the transplanted islets. There are not many known signs of rejection in islet transplant recipients. A rise in blood sugar levels could indicate rejection. If an unexpected rise in blood sugars occurs, it should be reported to the transplant team immediately.

More About Immunosuppressants

There are many unpleasant side effects that may occur when taking immunosuppressants. Every patient will not get all the side effects listed for every drug. A patient may not experience any side effects at all, but it is important that each patient know what to watch for.

Infections

Because these medicines weaken the immune system, the patient is at increased risk for infections. Other medications are taken that will help prevent infections. As doses of immunosuppressants are stabilized, the risk for infection goes down. Some helpful hints to help prevent infection:

• Hand washing is the best way to prevent infection
• Cuts or scrapes should be cleaned with soap and water
• Do not to share eating utensils or drink after another person
• Avoid people that have infections like colds or the flu
• Get an annual flu shot
• Report any symptoms of infection to the transplant team right away!
• Do not keep exotic pets or birds
• Do not wear artificial nails

Even with the best efforts, infection may develop. When the immune system is unable to control an infection, there are certain signs and symptoms. Here are some warning signs to be aware of:

• Fever, chills, sore throat
• Nausea, vomiting, diarrhea
• Headache, earache, sinus drainage
• Coughing up mucus or green sputum
• Enlarged neck glands
• Pain, redness, pus, or swelling around a wound
• Painful urination
• Feeling tired, achy, or weak

Cancer

Immunosuppressants increase the risk for developing certain kinds of cancers. Some helpful hints to help prevent or detect cancer:

• ALWAYS use maximum sun block protection on the face. When exposed to the sun wear a hat and maximum sun block on exposed areas such as arms and shoulders. Do not sunbathe or use tanning beds.
• Have any unusual skin growths examined right away.
• For women – have an annual gynecology exam and pap smear, perform regular breast self-examinations, and have an annual mammogram
• For men – have an annual prostate exam and perform regular testicular self-examinations
• Report any suspicious skin growth, swelling or lump to the transplant team

Cytomegalovirus

Cytomegalovirus, or CMV, is a very common virus. About 70% of adults have had a CMV infection. It usually causes a flu-like illness with fever, general body aches, and a decreased appetite that lasts for 2 to 3 days. During CMV infection the body forms antibodies that protect from future CMV infection. Patients will be tested for antibodies to see if they have had CMV. Patients taking immunosuppressant drugs are at increased risk of a recurrent CMV infection. During the first few months after transplant, the CMV can “reactivate” or “wake up”. A CMV infection can be serious in a transplant patient. Transplant patients are given Cytovene during the first few months following a transplant to protect them from developing an active CMV infection.

Anyone undergoing islet transplantation may develop complications. It is important to understand the possible risks involved before deciding to participate in this research. The transplant team will help the patient understand the warning signs of possible complications and recommend further treatment when necessary.

Transplant Center