Friday, September 17, 2004

Islet cell transplants on hold

Diabetes treatment stymied by no reimbursement

By Tim Bonfield
Enquirer staff writer

University Hospital has stopped performing a type of islet cell transplant that was touted three years ago as a potential breakthrough treatment for diabetes.

After treating six patients and despite initial signs of success, the program quietly stopped several months ago, primarily because the hospital can no longer afford to offer the treatment, which can cost more than $200,000, officials said.

"The islet cell transplant program brings real hope for many individuals affected by type I diabetes. However, third-party payers and Medicare still consider islet transplantation experimental and do not reimburse University Hospital or the physicians for the procedure," said James Kingsbury, senior vice president of the Health Alliance of Greater Cincinnati.

Islet cells are the insulin-producing part of the pancreas. Islet cell transplants - rather than full-blown pancreas transplants - continue to be a heavily researched field for diabetes treatment.

The lack of reimbursement combined with the rising costs of obtaining donated organs and of processing the islet cells made it too hard to sustain the program, said Dr. E. Steve Woodle, University Hospital's director of transplantation.

The local islet cell transplant program was launched in 2001 with considerable publicity. Officials were especially excited by the case of Loveland resident Lois Vicars, who achieved insulin independence after a single transplant in April 2002.

But money issues emerged after the medical center underwrote nearly all the costs of the first six cases.

After launching the program, University Hospital in conjunction with the University of Cincinnati tried to be included in a network of about a dozen centers that have been receiving federal grants and support.

The grants came from the Juvenile Diabetes Research Foundation to continue islet cell programs.

But the effort was rejected, Woodle said.

Several islet cell transplant programs remain open in the United States, Canada and Europe - including large programs at the University of Minnesota and the University of Miami (Florida). But overall, the islet cell transplant field still faces deep challenges.

A report issued in July recaps how 86 patients fared after transplants performed since 1999, when an improved transplant method was developed.

More than 60 percent of patients were no longer taking insulin a year after their transplants - up from about 8 percent in more than 100 cases attempted before 1999, according to the report. .

However, most patients needed cells from more than one pancreas to achieve success - a significant problem given the overall shortage of donated organs.

University Hospital continues to perform islet cell transplants using a patient's own cells, but those cases are to prevent diabetes from starting in people who suffer pancreas disease or injury - not to reverse diabetes in cases where the pancreas hasn't functioned properly for years.

Because that service continues, University Hospital will be ready to re-launch its full-blown islet cell transplant program should the financial picture improve, Woodle said.


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