BACKGROUND: Pancreas and islet transplantation are the only available options to replace beta-cell function in patients with type 1 diabetes. Great variability in terms of rate of success for both approaches is reported in the literature and it is difficult to compare the respective risks and benefits. OBJECTIVES: The aim of this study was to analyze risks and benefits of pancreas transplantation alone (PTA) and islet transplantation alone (ITA) by making use of the long-term experience of a single center where both transplantations are performed. We focused on the risks and benefits of both procedures, with the objective of better defining indications and providing evidence to support the decision-making process. The outcomes of 33 PTA and 33 ITA were analyzed, and pancreas and islet function (i.e., insulin independence), perioperative events, and long-term adverse events were recorded. RESULTS: We observed a higher rate of insulin independence in PTA (75%) versus ITA (59%), with the longer insulin independence among PTA patients receiving tacrolimus. The occurrence of adverse events was higher for PTA patients in terms of hospitalization length and frequency, re-intervention for surgical and immunological acute complications, CMV reactivation, and other infections. CONCLUSIONS: In conclusion, these results support the practice of listing patients for PTA when the metabolic control and the progression of chronic complications require a rapid normalization of glucose levels, with the exception of patients with cardiovascular disease, because of the high surgical risks. ITA is indicated when replacement of beta-cell mass is needed in patients with a high surgical risk.
BACKGROUND: Pancreas and islet transplantation are the only available options to replace beta-cell function in patients with type 1 diabetes. Great variability in terms of rate of success for both approaches is reported in the literature and it is difficult to compare the respective risks and benefits. OBJECTIVES: The aim of this study was to analyze risks and benefits of pancreas transplantation alone (PTA) and islet transplantation alone (ITA) by making use of the long-term experience of a single center where both transplantations are performed. We focused on the risks and benefits of both procedures, with the objective of better defining indications and providing evidence to support the decision-making process. The outcomes of 33 PTA and 33 ITA were analyzed, and pancreas and islet function (i.e., insulin independence), perioperative events, and long-term adverse events were recorded. RESULTS: We observed a higher rate of insulin independence in PTA (75%) versus ITA (59%), with the longer insulin independence among PTA patients receiving tacrolimus. The occurrence of adverse events was higher for PTA patients in terms of hospitalization length and frequency, re-intervention for surgical and immunological acute complications, CMV reactivation, and other infections. CONCLUSIONS: In conclusion, these results support the practice of listing patients for PTA when the metabolic control and the progression of chronic complications require a rapid normalization of glucose levels, with the exception of patients with cardiovascular disease, because of the high surgical risks. ITA is indicated when replacement of beta-cell mass is needed in patients with a high surgical risk.
Authors: Bernhard J Hering; Raja Kandaswamy; Jeffrey D Ansite; Peter M Eckman; Masahiko Nakano; Toshiya Sawada; Ippei Matsumoto; Sung-Hee Ihm; Hui-Jian Zhang; Jamen Parkey; David W Hunter; David E R Sutherland Journal: JAMA Date: 2005-02-16 Impact factor: 56.272
Authors: D E Sutherland; R W Gruessner; D L Dunn; A J Matas; A Humar; R Kandaswamy; S M Mauer; W R Kennedy; F C Goetz; R P Robertson; A C Gruessner; J S Najarian Journal: Ann Surg Date: 2001-04 Impact factor: 12.969
Authors: Jeremy J Heit; Asa A Apelqvist; Xueying Gu; Monte M Winslow; Joel R Neilson; Gerald R Crabtree; Seung K Kim Journal: Nature Date: 2006-09-21 Impact factor: 49.962
Authors: A M Shapiro; J R Lakey; E A Ryan; G S Korbutt; E Toth; G L Warnock; N M Kneteman; R V Rajotte Journal: N Engl J Med Date: 2000-07-27 Impact factor: 91.245
Authors: Nassir Rostambeigi; Yogish C Kudva; Seby John; Sham Mailankody; Rachel A Pedersen; Patrick G Dean; Mikel Prieto; Fernando G Cosio; Walter K Kremers; Randall C Walker; Roshini S Abraham; Mark D Stegall Journal: Transplantation Date: 2010-05-15 Impact factor: 4.939
Authors: S T Bartlett; E J Schweitzer; L B Johnson; P C Kuo; J C Papadimitriou; C B Drachenberg; D K Klassen; E W Hoehn-Saric; M R Weir; A L Imbembo Journal: Ann Surg Date: 1996-10 Impact factor: 12.969
Authors: James D Johnson; Zhiqiang Han; Kenichi Otani; Honggang Ye; Yan Zhang; Hong Wu; Yukio Horikawa; Stanley Misler; Graeme I Bell; Kenneth S Polonsky Journal: J Biol Chem Date: 2004-03-25 Impact factor: 5.157
Authors: S Moassesfar; U Masharani; L A Frassetto; G L Szot; M Tavakol; P G Stock; A M Posselt Journal: Am J Transplant Date: 2015-11-23 Impact factor: 8.086