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The current state of pancreas transplantation

Abstract

For many patients with type 1 diabetes mellitus and selected patients with type 2 diabetes mellitus, a successful pancreas transplant is the only definitive long-term treatment that both restores euglycaemia without the risk of severe hypoglycaemia and prevents, halts or reverses secondary complications. These benefits come at the cost of major surgery and lifelong immunosuppression. Nevertheless, pancreas transplants are safe and effective, with patient survival rates currently >95% at 1 year and >88% at 5 years; graft survival rates are almost 85% at 1 year and >60% at 5 years. The estimated half-life of a pancreas graft is now 7–14 years. The improvements in graft survival are attributable to considerable reductions in technical failures and in immunologic graft losses. Pancreas recipients have reduced mortality compared with waiting candidates or patients with diabetes mellitus who undergo a kidney transplant alone. Pancreas transplants should be more frequently offered to nonuraemic patients with brittle diabetes mellitus to prevent the development of secondary diabetic complications and to avoid the need for a kidney transplant. Although the results of islet transplantation have also improved, islet recipients rarely maintain long-term insulin independence despite the use of multiple organ donor pancreases. Pancreas transplants and islet transplants should be considered complementary, not mutually exclusive, procedures that are chosen on the basis of the individual patient's surgical risk.

Key Points

  • Pancreas transplants in appropriately selected patients with diabetes mellitus have evolved into a safe and very effective treatment to restore euglycaemia without the risk of severe hypoglycaemia

  • Pancreas transplants are an option for many patients with type 1 diabetes mellitus, selected patients with type 2 diabetes mellitus and selected patients with surgery-induced diabetes mellitus

  • A successful pancreas transplant can prevent, halt or reverse the development or progression of secondary complications of diabetes mellitus

  • Outcomes at 1-year after transplant have considerably improved, with rates of patient survival now at >95% and graft survival rates (insulin independence) at almost 85%

  • A future shift to offering pancreas transplants to patients with diabetes mellitus without uraemia (rather than transplants for those with uraemia or posturaemia) seems to be desirable

  • Transplants of the pancreas or islets are complementary procedures chosen on the basis of surgical risk; until islet transplants achieve long-term insulin independence, pancreas transplant remains the treatment of choice

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Figure 1: Patient survival after pancreas transplantation over time.
Figure 2: Pancreas graft survival over time.

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Acknowledgements

The authors would like to thank M. Knatterud and J. Roberts from the Department of Surgery at the University of Arizona, USA, for their help with preparing the manuscript.

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Correspondence to Rainer W. G. Gruessner.

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Gruessner, R., Gruessner, A. The current state of pancreas transplantation. Nat Rev Endocrinol 9, 555–562 (2013). https://doi.org/10.1038/nrendo.2013.138

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