Background: Islet allograft transplantation (IAT) is an experimental intervention for diabetes mellitus that attempts to resolve hypoglycemic unawareness and establish insulin independence as an alternative to whole organ pancreas transplantation. David Sutherland and John Najarian performed the first clinical IAT at the University of Minnesota in 1974. The courageousness of the early clinical work by these investigators speaks to the vision of the Department of Surgery (DOS) and its commitment to revolutionizing beta cell transplantation.
Objective: This historical review describes the contributions of the University of Minnesota’s DOS in the development of islet allotransplantation through analysis of the department’s academic output from 1973-1979 and considers the factors leading to the emergence of the UMN as a world-leading islet transplantation center - continuing today to be one of three centers approved for phase 3 FDA trials for islet transplantation.
Methods: We analyzed archival material at the Wangensteen Historical library, where the compiled publications of the UMN DOS from 1973-1979. Publications were included that discussed IAT which were tabulated and calculated as a proportion of the department’s total publications for each year. We calculated the percentage of publications, number of investigators, and basic vs clinical research.
Results: Between 1973 and 1979, the proportion of publications that discuss IAT ranged from 0% to 8.3% of DOS total academic output. The proportion of clinical publications to basic science publications increased from 0% to 11% over the period. The number of authors affiliated with IAT ranged from 0 in 1973 to 13 in 1977; the total number of unique authors over the time period was 31 investigators. The proportion spikes in 1977, the year that the first clinical paper was published, which outlines the first cohort of islet allografts that were completed between 1974 and 1975. The majority of these publications describe the basic science and preclinical work needed to transition to clinical application and speak to the challenges of islet allotransplantation.
Conclusion: Though sustained insulin independence was not achieved through islet transplantation until the early 1990s, the institutional commitment to transplant medicine through recruitment of islet research leaders, interdepartmental and interprofessional collaboration, completion of preclinical animal and initial human trials, provided the necessary groundwork and experience that revolutionized how we care for and understand patients with diabetes. We also see how historical research can help us appreciate the nonlinear nature of scientific inquiry and inform our decision-making for how to commit valuable resources in basic and translational research to find innovative solutions to complex problems.
Figure 1. Distribution of publications regarding IAT from the Department of Surgery at the University of Minnesota, 1973-1979.
Table 1. Results of archival review of compiled publications from the Department of Surgery at the University of Minnesota, 1973-1979.
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