Appropriateness and timing of kidney and/or pancreas transplants in type 1 and type 2 diabetes.

Cure of diabetes through cell or organ transplantation remains an unattained but highly desirable goal. For now, prevention of end organ complications of diabetes is the most appropriate application of transplantation for patients with enough evidence of progressive disease to justify the substantial surgical and immunosuppression-based risks of pancreas transplantation. Uremic diabetics should, if possible, be offered renal transplantation, alone or in combination with pancreas transplantation, to obviate the excessive mortality associated with prolonged maintenance dialysis. Islet transplantation has been widely clinically unsuccessful but holds new promise as the therapy of choice for the future. This report reviews the history, state of the art, and selection process for timing and application of currently available transplantation modalities for diabetic patients.