rapamycin in islet transplantation: friend or foe?

The Edmonton protocol was undoubtedly a major step forward in the history
of islet transplantation. Its immunosuppression regimen was largely based on
the mTOR inhibitor rapamycin (sirolimus), which remains the most frequently
used immunosuppressive drug in clinical islet transplant protocols. As time
reveals the somewhat disappointing long-term results achieved with the
Edmonton protocol, a number of publications have appeared addressing
the potential beneficial or deleterious role of rapamycin on islet cell engraftment,
function survival and regeneration, as well as on its side-effects in
human subjects. This paper reviews the sometimes contradictory evidence on
the impact of rapamycin in islet transplantation.