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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: Nov 2017. | This topic last updated: Mar 07, 2016.
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