Pancreas and islet transplants for patients with diabetes: taking positions and making decisions.
OBJECTIVE
To help endocrinologists develop a position and then make decisions about the applicability of pancreas and islet transplantations for treatment of patients with diabetes.


METHODS
An overview is provided of peer-reviewed literature reporting clinical outcomes of pancreas and islet transplantations, emphasizing rates of success, effect on metabolic regulation and secondary complications, and changes in the quality of life.


RESULTS
Pancreas transplantation-related patient survival rates correspond generally to survival rates of similar patients who have not undergone transplantation, and organ survival rates are consistent with rates of other commonly transplanted organs. Beneficial effects include normalization of glycemia; restoration of glucagon, epinephrine, and symptom responses to hypoglycemia; stabilization of renal and neural complications; and improvement in the quality of life. Autoislet transplantation is commonly successful in preventing diabetes attributable to pancreatectomy for chronic pancreatitis. The success rates associated with alloislet transplantation remain low.


CONCLUSIONS
Pancreas transplantation is a therapeutic, not an experimental, option that should be considered when patients with diabetes are candidates for kidney transplantation or when they are metabolically unstable despite optimal medical management. Autoislet transplantation is a therapeutic option that should be seriously considered for patients without diabetes destined to undergo pancreatectomy for chronic pancreatitis. Alloislet transplantation remains an experimental procedure for treatment of diabetes.
Robertson
R P
RP
Pacific Northwest Research Institute and Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, Washington, USA.