Immune monitoring of allogeneic islets

Abstract Pancreatic islet cells are responsible for the endocrine function of the pancreas. The transplantation of allogeneic islets is therefore a promising alternative to solid organ pancreas transplantation in the treatment of end-stage diabetes and insulin dependence. Islet transplantation may avoid potential open surgical complications while still restoring glucose homeostasis. However, overcoming rejection of pancreatic islets remains challenging, as does diagnosis of early rejection and subsequent dysfunction. Immune monitoring of the pancreatic islet transplant is a field of active investigation, as the majority of islet transplant recipients return to insulin dependence within only a few years due to chronic rejection. In this chapter, we review mechanisms of islet allograft rejection, current methods of graft monitoring, and current research and innovation in the immune monitoring of allogeneic islets.