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Pancreas and islet transplantation in diabetes mellitus

R Paul Robertson, MD
Section Editor
Irl B Hirsch, MD
Deputy Editor
Jean E Mulder, MD


The Diabetes Control and Complication Trial (DCCT) demonstrated that intensive therapy aimed at lower levels of glycemia results in decreased rates of retinopathy, nephropathy, and neuropathy in type 1 diabetes patients. In the Epidemiology of Diabetes Interventions and Complications (EDIC) follow-up study to the DCCT, intensive insulin therapy in patients with type 1 diabetes decreased fatal and nonfatal cardiovascular events. (See "Glycemic control and vascular complications in type 1 diabetes mellitus".)

What was considered “intensive therapy” in the DCCT is now considered to be standard therapy for management of type 1 diabetes. However, intensive insulin therapy (three or more injections per day or continuous subcutaneous insulin infusion with an insulin pump) is successful only if the patient is fully committed to it, has good understanding of the regimen, and is supported by a health care team with sufficient enthusiasm and expertise to educate the patient and to continuously monitor his or her progress. For these reasons, alternative options for achieving near normal glycemia in patients with type 1 diabetes are desirable. The goal of transplantation is to allow insulin independence, improve quality of life, and reduce secondary complications.

This topic will briefly review the history, techniques, and clinical results of pancreas and pancreatic islet transplantation in hyperglycemic patients with long-standing type 1 diabetes mellitus, with a focus upon transplantation of islet or pancreatic tissue alone. Combined pancreas-kidney transplantation is discussed separately. (See "Patient selection for and immunologic issues relating to kidney-pancreas transplantation in diabetes mellitus" and "Benefits and complications associated with kidney-pancreas transplantation in diabetes mellitus".)


The goals of transplantation are to restore glucose-regulated endogenous insulin secretion, arrest the progression of the complications of diabetes, and improve quality of life. Both pancreas and islet transplantation require lifelong immunosuppression to prevent rejection of the graft and recurrence of the autoimmune process. Conventional maintenance regimens consist of a combination of immunosuppressive agents that differ by mechanism of action. This strategy minimizes morbidity and mortality associated with each class of agent while maximizing overall effectiveness. However, the immunosuppressive agents used in transplantation often have side effects (eg, diarrhea, neutropenia, anemia, fatigue, hypertension) severe enough to adversely affect quality of life. Thus, transplantation is generally considered only in patients with serious progressive complications of diabetes in whom the quality of life is unacceptable.

The American Diabetes Association (ADA) criteria for transplantation are as follows [1]:

Patients with end stage renal disease who have had or plan to have a kidney transplant are candidates for pancreas transplantation. The successful transplantation of a pancreas will improve glycemia and may improve kidney survival. Most pancreatic transplants are performed in patients with diabetes and end stage renal disease. The majority of these patients receive simultaneous pancreas-kidney transplantation rather than pancreas after kidney transplantation. (See "Patient selection for and immunologic issues relating to kidney-pancreas transplantation in diabetes mellitus".)


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Literature review current through: Sep 2016. | This topic last updated: Mar 7, 2016.
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  1. Robertson RP, Davis C, Larsen J, et al. Pancreas and islet transplantation in type 1 diabetes. Diabetes Care 2006; 29:935.
  2. Maffi P, Scavini M, Socci C, et al. Risks and benefits of transplantation in the cure of type 1 diabetes: whole pancreas versus islet transplantation. A single center study. Rev Diabet Stud 2011; 8:44.
  3. 2008 SRTR Report on the State of Transplanation: Kindy and pancreas transplantation in the United States, 1998-2007: Access for patiens with diabetes and ESRD. Available at: http://www.ustransplant.org/publications/show_Citation.aspx?id=370 (Accessed on September 26, 2011).
  4. Niclauss N, Morel P, Volonte F, et al. [Pancreas and islets of Langerhans transplantation: current status in 2009 and perspectives]. Rev Med Suisse 2009; 5:1266.
  5. Collaborative Islet Transplant Registry. Available at: http://www.citregistry.com/ (Accessed on September 28, 2011).
  6. Khan MH, Harlan DM. Counterpoint: clinical islet transplantation: not ready for prime time. Diabetes Care 2009; 32:1570.
  7. Mineo D, Pileggi A, Alejandro R, Ricordi C. Point: steady progress and current challenges in clinical islet transplantation. Diabetes Care 2009; 32:1563.
  8. Kelly WD, Lillehei RC, Merkel FK, et al. Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy. Surgery 1967; 61:827.
  9. McCullough KP, Keith DS, Meyer KH, et al. Kidney and pancreas transplantation in the United States, 1998-2007: access for patients with diabetes and end-stage renal disease. Am J Transplant 2009; 9:894.
  10. United Network for Organ Sharing http://www.unos.org/donation/index.php?topic=data (Accessed on November 05, 2012).
  11. USTransplant.org: Arbor Research Collaborative For Health www.ustransplant.org (Accessed on September 30, 2011).
  12. Sutherland DE, Gruessner RW, Dunn DL, et al. Lessons learned from more than 1,000 pancreas transplants at a single institution. Ann Surg 2001; 233:463.
  13. Gruessner AC. 2011 update on pancreas transplantation: comprehensive trend analysis of 25,000 cases followed up over the course of twenty-four years at the International Pancreas Transplant Registry (IPTR). Rev Diabet Stud 2011; 8:6.
  14. Axelrod DA, Sung RS, Meyer KH, et al. Systematic evaluation of pancreas allograft quality, outcomes and geographic variation in utilization. Am J Transplant 2010; 10:837.
  15. Venstrom JM, McBride MA, Rother KI, et al. Survival after pancreas transplantation in patients with diabetes and preserved kidney function. JAMA 2003; 290:2817.
  16. Nathan DM. Isolated pancreas transplantation for type 1 diabetes: a doctor's dilemma. JAMA 2003; 290:2861.
  17. Gruessner RW, Sutherland DE, Gruessner AC. Mortality assessment for pancreas transplants. Am J Transplant 2004; 4:2018.
  18. Pozza G, Traeger J, Dubernard JM, et al. Endocrine responses of type 1 (insulin-dependent) diabetic patients following successful pancreas transplantation. Diabetologia 1983; 24:244.
  19. Katz H, Homan M, Velosa J, et al. Effects of pancreas transplantation on postprandial glucose metabolism. N Engl J Med 1991; 325:1278.
  20. Diem P, Abid M, Redmon JB, et al. Systemic venous drainage of pancreas allografts as independent cause of hyperinsulinemia in type I diabetic recipients. Diabetes 1990; 39:534.
  21. Osei K, Henry ML, O'Dorisio TM, et al. Physiological and pharmacological stimulation of pancreatic islet hormone secretion in type I diabetic pancreas allograft recipients. Diabetes 1990; 39:1235.
  22. Elahi D, Clark BA, McAloon-Dyke M, et al. Islet cell responses to glucose in human transplanted pancreas. Am J Physiol 1991; 261:E800.
  23. Robertson RP, Diem P, Sutherland DE. Time-related, cross-sectional and prospective follow-up of pancreatic endocrine function after pancreas allograft transplantation in type 1 (insulin-dependent) diabetic patients. Diabetologia 1991; 34 Suppl 1:S57.
  24. Landgraf R, Nusser J, Riepl RL, et al. Metabolic and hormonal studies of type 1 (insulin-dependent) diabetic patients after successful pancreas and kidney transplantation. Diabetologia 1991; 34 Suppl 1:S61.
  25. Secchi A, Dubernard JM, La Rocca E, et al. Endocrinometabolic effects of whole versus segmental pancreas allotransplantation in diabetic patients--a two-year follow-up. Transplantation 1991; 51:625.
  26. Luzi L, Secchi A, Facchini F, et al. Reduction of insulin resistance by combined kidney-pancreas transplantation in type 1 (insulin-dependent) diabetic patients. Diabetologia 1990; 33:549.
  27. La Rocca E, Secchi A, Parlavecchia M, et al. Lipid metabolism after successful kidney and pancreatic transplantation. Transplant Proc 1991; 23:1672.
  28. Larsen JL, Stratta RJ, Ozaki CF, et al. Lipid status after pancreas-kidney transplantation. Diabetes Care 1992; 15:35.
  29. Katz HH, Nguyen TT, Velosa JA, et al. Effects of systemic delivery of insulin on plasma lipids and lipoprotein concentrations in pancreas transplant recipients. Mayo Clin Proc 1994; 69:231.
  30. Diem P, Redmon JB, Abid M, et al. Glucagon, catecholamine and pancreatic polypeptide secretion in type I diabetic recipients of pancreas allografts. J Clin Invest 1990; 86:2008.
  31. Barrou Z, Seaquist ER, Robertson RP. Pancreas transplantation in diabetic humans normalizes hepatic glucose production during hypoglycemia. Diabetes 1994; 43:661.
  32. Kendall DM, Rooney DP, Smets YF, et al. Pancreas transplantation restores epinephrine response and symptom recognition during hypoglycemia in patients with long-standing type I diabetes and autonomic neuropathy. Diabetes 1997; 46:249.
  33. Cottrell DA, Henry ML, O'Dorisio TM, et al. Hypoglycemia after successful pancreas transplantation in type I diabetic patients. Diabetes Care 1991; 14:1111.
  34. Redmon JB, Teuscher AU, Robertson RP. Hypoglycemia after pancreas transplantation. Diabetes Care 1998; 21:1944.
  35. Bellin MD, Parazzoli S, Oseid E, et al. Defective glucagon secretion during hypoglycemia after intrahepatic but not nonhepatic islet autotransplantation. Am J Transplant 2014; 14:1880.
  36. Paty BW, Ryan EA, Shapiro AM, et al. Intrahepatic islet transplantation in type 1 diabetic patients does not restore hypoglycemic hormonal counterregulation or symptom recognition after insulin independence. Diabetes 2002; 51:3428.
  37. Zhou H, Zhang T, Bogdani M, et al. Intrahepatic glucose flux as a mechanism for defective intrahepatic islet alpha-cell response to hypoglycemia. Diabetes 2008; 57:1567.
  38. Robertson RP, Sutherland DE, Kendall DM, et al. Metabolic characterization of long-term successful pancreas transplants in type I diabetes. J Investig Med 1996; 44:549.
  39. Robertson RP, Sutherland DE, Lanz KJ. Normoglycemia and preserved insulin secretory reserve in diabetic patients 10-18 years after pancreas transplantation. Diabetes 1999; 48:1737.
  40. Bohman SO, Tydén G, Wilczek H, et al. Prevention of kidney graft diabetic nephropathy by pancreas transplantation in man. Diabetes 1985; 34:306.
  41. Bilous RW, Mauer SM, Sutherland DE, et al. The effects of pancreas transplantation on the glomerular structure of renal allografts in patients with insulin-dependent diabetes. N Engl J Med 1989; 321:80.
  42. Fioretto P, Steffes MW, Sutherland DE, et al. Reversal of lesions of diabetic nephropathy after pancreas transplantation. N Engl J Med 1998; 339:69.
  43. Navarro X, Sutherland DE, Kennedy WR. Long-term effects of pancreatic transplantation on diabetic neuropathy. Ann Neurol 1997; 42:727.
  44. Secchi A, Martinenghi S, Galardi G, et al. Effects of pancreatic transplantation on diabetic polyneuropathy. Transplant Proc 1991; 23:1658.
  45. Aridge D, Reese J, Niehoff M, et al. Effect of successful renal and segmental pancreatic transplantation on peripheral and autonomic neuropathy. Transplant Proc 1991; 23:1670.
  46. Allen RD, Al-Harbi IS, Morris JG, et al. Diabetic neuropathy after pancreas transplantation: determinants of recovery. Transplantation 1997; 63:830.
  47. Navarro X, Kennedy WR, Sutherland DE. Autonomic neuropathy and survival in diabetes mellitus: effects of pancreas transplantation. Diabetologia 1991; 34 Suppl 1:S108.
  48. Gaber AO, Cardoso S, Pearson S, et al. Improvement in autonomic function following combined pancreas-kidney transplantation. Transplant Proc 1991; 23:1660.
  49. Navarro X, Kennedy WR, Loewenson RB, Sutherland DE. Influence of pancreas transplantation on cardiorespiratory reflexes, nerve conduction, and mortality in diabetes mellitus. Diabetes 1990; 39:802.
  50. Ramsay RC, Goetz FC, Sutherland DE, et al. Progression of diabetic retinopathy after pancreas transplantation for insulin-dependent diabetes mellitus. N Engl J Med 1988; 318:208.
  51. Petersen MR, Vine AK. Progression of diabetic retinopathy after pancreas transplantation. The University of Michigan Pancreas Transplant Evaluation Committee. Ophthalmology 1990; 97:496.
  52. Scheider A, Meyer-Schwickerath E, Nusser J, et al. Diabetic retinopathy and pancreas transplantation: a 3-year follow-up. Diabetologia 1991; 34 Suppl 1:S95.
  53. Wang Q, Klein R, Moss SE, et al. The influence of combined kidney-pancreas transplantation on the progression of diabetic retinopathy. A case series. Ophthalmology 1994; 101:1071.
  54. Koznarová R, Saudek F, Sosna T, et al. Beneficial effect of pancreas and kidney transplantation on advanced diabetic retinopathy. Cell Transplant 2000; 9:903.
  55. Markowski DM, Larsen JL, McElligott MC, et al. Diet after pancreas transplantation. Diabetes Care 1996; 19:735.
  56. Fiorina P, La Rocca E, Venturini M, et al. Effects of kidney-pancreas transplantation on atherosclerotic risk factors and endothelial function in patients with uremia and type 1 diabetes. Diabetes 2001; 50:496.
  57. Larsen JL, Colling CW, Ratanasuwan T, et al. Pancreas transplantation improves vascular disease in patients with type 1 diabetes. Diabetes Care 2004; 27:1706.
  58. Jukema JW, Smets YF, van der Pijl JW, et al. Impact of simultaneous pancreas and kidney transplantation on progression of coronary atherosclerosis in patients with end-stage renal failure due to type 1 diabetes. Diabetes Care 2002; 25:906.
  59. Sutherland DE, Gruessner R, Dunn D, et al. Pancreas transplants from living-related donors. Transplant Proc 1994; 26:443.
  60. Knight RJ, Kerman RH, Zela S, et al. Pancreas transplantation utilizing thymoglobulin, sirolimus, and cyclosporine. Transplantation 2006; 81:1101.
  61. Havrdova T, Saudek F, Boucek P, et al. Metabolic effect of sirolimus versus mycophenolate mofetil on pancreatic graft function in the early posttransplant period. Transplant Proc 2005; 37:3544.
  62. Gautam A, Morrissey PE, Gohh R, et al. Experience with sirolimus for calcineurin minimization/elimination in pancreas-after-kidney transplantation. Transplant Proc 2005; 37:3542.
  63. Rogers J, Ashcraft EE, Emovon OE, et al. Long-term outcome of sirolimus rescue in kidney-pancreas transplantation. Transplantation 2004; 78:619.
  64. Kaufman DB, Leventhal JR, Gallon LG, Parker MA. Alemtuzumab induction and prednisone-free maintenance immunotherapy in simultaneous pancreas-kidney transplantation comparison with rabbit antithymocyte globulin induction - long-term results. Am J Transplant 2006; 6:331.
  65. Luo G, Falta EM, Elster EA. Steroid-free immunosuppression in organ transplantation. Curr Diab Rep 2005; 5:305.
  66. Mark W, Berger N, Lechleitner M, et al. Impact of steroid withdrawal on metabolic parameters in a series of 112 enteric/systemic-drained pancreatic transplants. Transplant Proc 2005; 37:1821.
  67. Cantarovich D, Karam G, Hourmant M, et al. Steroid avoidance versus steroid withdrawal after simultaneous pancreas-kidney transplantation. Am J Transplant 2005; 5:1332.
  68. Uemura T, Ramprasad V, Matsushima K, et al. Single dose of alemtuzumab induction with steroid-free maintenance immunosuppression in pancreas transplantation. Transplantation 2011; 92:678.
  69. Humar A, Ramcharan T, Kandaswamy R, et al. Technical failures after pancreas transplants: why grafts fail and the risk factors--a multivariate analysis. Transplantation 2004; 78:1188.
  70. Drachenberg CB, Papadimitriou JC, Farney A, et al. Pancreas transplantation: the histologic morphology of graft loss and clinical correlations. Transplantation 2001; 71:1784.
  71. Gruessner A, Sutherland DE. Pancreas transplantation in the United States (US) and non-US as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR). Clin Transpl 1996; :47.
  72. Gruessner RW, Sutherland DE, Najarian JS, et al. Solitary pancreas transplantation for nonuremic patients with labile insulin-dependent diabetes mellitus. Transplantation 1997; 64:1572.
  73. Gruessner RW, Nakhleh R, Tzardis P, et al. Rejection patterns after simultaneous pancreaticoduodenal-kidney transplants in pigs. Transplantation 1994; 57:756.
  74. Pirsch JD, Andrews C, Hricik DE, et al. Pancreas transplantation for diabetes mellitus. Am J Kidney Dis 1996; 27:444.
  75. Papadimitriou JC, Drachenberg CB, Wiland A, et al. Histologic grading of acute allograft rejection in pancreas needle biopsy: correlation to serum enzymes, glycemia, and response to immunosuppressive treatment. Transplantation 1998; 66:1741.
  76. Stiller CR, Dupré J, Gent M, et al. Effects of cyclosporine immunosuppression in insulin-dependent diabetes mellitus of recent onset. Science 1984; 223:1362.
  77. Benedetti E, Najarian JS, Gruessner AC, et al. Correlation between cystoscopic biopsy results and hypoamylasuria in bladder-drained pancreas transplants. Surgery 1995; 118:864.
  78. Kuhr CS, Davis CL, Barr D, et al. Use of ultrasound and cystoscopically guided pancreatic allograft biopsies and transabdominal renal allograft biopsies: safety and efficacy in kidney-pancreas transplant recipients. J Urol 1995; 153:316.
  79. Robertson RP. Islet transplantation as a treatment for diabetes - a work in progress. N Engl J Med 2004; 350:694.
  80. Rother KI, Harlan DM. Challenges facing islet transplantation for the treatment of type 1 diabetes mellitus. J Clin Invest 2004; 114:877.
  81. Warnock GL, Kneteman NM, Ryan EA, et al. Long-term follow-up after transplantation of insulin-producing pancreatic islets into patients with type 1 (insulin-dependent) diabetes mellitus. Diabetologia 1992; 35:89.
  82. Shapiro AM, Lakey JR, Ryan EA, et al. Islet transplantation in seven patients with type 1 diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. N Engl J Med 2000; 343:230.
  83. Vardanyan M, Parkin E, Gruessner C, Rodriguez Rilo HL. Pancreas vs. islet transplantation: a call on the future. Curr Opin Organ Transplant 2010; 15:124.
  84. Sutherland DE, Radosevich DM, Bellin MD, et al. Total pancreatectomy and islet autotransplantation for chronic pancreatitis. J Am Coll Surg 2012; 214:409.
  85. Najarian JS, Sutherland DE, Baumgartner D, et al. Total or near total pancreatectomy and islet autotransplantation for treatment of chronic pancreatitis. Ann Surg 1980; 192:526.
  86. Bellin MD, Carlson AM, Kobayashi T, et al. Outcome after pancreatectomy and islet autotransplantation in a pediatric population. J Pediatr Gastroenterol Nutr 2008; 47:37.
  87. Pyzdrowski KL, Kendall DM, Halter JB, et al. Preserved insulin secretion and insulin independence in recipients of islet autografts. N Engl J Med 1992; 327:220.
  88. Robertson RP, Lanz KJ, Sutherland DE, Kendall DM. Prevention of diabetes for up to 13 years by autoislet transplantation after pancreatectomy for chronic pancreatitis. Diabetes 2001; 50:47.
  89. Wahoff DC, Papalois BE, Najarian JS, et al. Autologous islet transplantation to prevent diabetes after pancreatic resection. Ann Surg 1995; 222:562.
  90. Robertson RP, Bogachus LD, Oseid E, et al. Assessment of β-cell mass and α- and β-cell survival and function by arginine stimulation in human autologous islet recipients. Diabetes 2015; 64:565.
  91. Robertson RP. Successful islet transplantation for patients with diabetes--fact or fantasy? N Engl J Med 2000; 343:289.
  92. Ryan EA, Paty BW, Senior PA, et al. Five-year follow-up after clinical islet transplantation. Diabetes 2005; 54:2060.
  93. Bromberg JS, LeRoith D. Diabetes cure--is the glass half full? N Engl J Med 2006; 355:1372.
  94. Shapiro AM, Ricordi C, Hering BJ, et al. International trial of the Edmonton protocol for islet transplantation. N Engl J Med 2006; 355:1318.
  95. Hafiz MM, Faradji RN, Froud T, et al. Immunosuppression and procedure-related complications in 26 patients with type 1 diabetes mellitus receiving allogeneic islet cell transplantation. Transplantation 2005; 80:1718.
  96. Berney T, Morel P. Islet transplantation: steeple chase and the next hurdle. Transplantation 2005; 80:1658.
  97. Campbell PM, Senior PA, Salam A, et al. High risk of sensitization after failed islet transplantation. Am J Transplant 2007; 7:2311.
  98. Markmann JF, Deng S, Huang X, et al. Insulin independence following isolated islet transplantation and single islet infusions. Ann Surg 2003; 237:741.
  99. Hirshberg B, Rother KI, Digon BJ 3rd, et al. Benefits and risks of solitary islet transplantation for type 1 diabetes using steroid-sparing immunosuppression: the National Institutes of Health experience. Diabetes Care 2003; 26:3288.
  100. Hering BJ, Kandaswamy R, Ansite JD, et al. Single-donor, marginal-dose islet transplantation in patients with type 1 diabetes. JAMA 2005; 293:830.
  101. Ramiya VK, Maraist M, Arfors KE, et al. Reversal of insulin-dependent diabetes using islets generated in vitro from pancreatic stem cells. Nat Med 2000; 6:278.
  102. D'Amour KA, Agulnick AD, Eliazer S, et al. Efficient differentiation of human embryonic stem cells to definitive endoderm. Nat Biotechnol 2005; 23:1534.
  103. Guo T, Hebrok M. Stem cells to pancreatic beta-cells: new sources for diabetes cell therapy. Endocr Rev 2009; 30:214.
  104. Kroon E, Martinson LA, Kadoya K, et al. Pancreatic endoderm derived from human embryonic stem cells generates glucose-responsive insulin-secreting cells in vivo. Nat Biotechnol 2008; 26:443.
  105. Stainier D. No stem cell is an islet (yet). N Engl J Med 2006; 354:521.
  106. Hao E, Tyrberg B, Itkin-Ansari P, et al. Beta-cell differentiation from nonendocrine epithelial cells of the adult human pancreas. Nat Med 2006; 12:310.
  107. Kodama S, Kühtreiber W, Fujimura S, et al. Islet regeneration during the reversal of autoimmune diabetes in NOD mice. Science 2003; 302:1223.
  108. Chong AS, Shen J, Tao J, et al. Reversal of diabetes in non-obese diabetic mice without spleen cell-derived beta cell regeneration. Science 2006; 311:1774.
  109. Nishio J, Gaglia JL, Turvey SE, et al. Islet recovery and reversal of murine type 1 diabetes in the absence of any infused spleen cell contribution. Science 2006; 311:1775.
  110. Suri A, Calderon B, Esparza TJ, et al. Immunological reversal of autoimmune diabetes without hematopoietic replacement of beta cells. Science 2006; 311:1778.
  111. Magliocca JF, Odorico JS. Embyonic stem cell-based therapy for the treatment of diabetes mellitus: a work in progress. Current Opinion in Organ Transplantation 2006; 11:88.
  112. Hering BJ, Wijkstrom M, Graham ML, et al. Prolonged diabetes reversal after intraportal xenotransplantation of wild-type porcine islets in immunosuppressed nonhuman primates. Nat Med 2006; 12:301.
  113. Kendall DM, Teuscher AU, Robertson RP. Defective glucagon secretion during sustained hypoglycemia following successful islet allo- and autotransplantation in humans. Diabetes 1997; 46:23.
  114. Gupta V, Wahoff DC, Rooney DP, et al. The defective glucagon response from transplanted intrahepatic pancreatic islets during hypoglycemia is transplantation site-determined. Diabetes 1997; 46:28.
  115. Merani S, Toso C, Emamaullee J, Shapiro AM. Optimal implantation site for pancreatic islet transplantation. Br J Surg 2008; 95:1449.
  116. Cantarelli E, Melzi R, Mercalli A, et al. Bone marrow as an alternative site for islet transplantation. Blood 2009; 114:4566.
  117. Calafiore R, Basta G, Luca G, et al. Grafts of microencapsulated pancreatic islet cells for the therapy of diabetes mellitus in non-immunosuppressed animals. Biotechnol Appl Biochem 2004; 39:159.
  118. Calafiore R, Basta G, Luca G, et al. Microencapsulated pancreatic islet allografts into nonimmunosuppressed patients with type 1 diabetes: first two cases. Diabetes Care 2006; 29:137.
  119. Eich T, Eriksson O, Lundgren T, Nordic Network for Clinical Islet Transplantation. Visualization of early engraftment in clinical islet transplantation by positron-emission tomography. N Engl J Med 2007; 356:2754.
  120. Barnett BP, Arepally A, Karmarkar PV, et al. Magnetic resonance-guided, real-time targeted delivery and imaging of magnetocapsules immunoprotecting pancreatic islet cells. Nat Med 2007; 13:986.