title: Transplantation for type I diabetes: comparison of vascularized whole-organ pancreas with isolated pancreatic islets.
abstract: OBJECTIVE
  We sought to compare the efficacy, risks, and costs of whole-organ pancreas transplantation (WOP) with the costs of isolated islet transplantation (IIT) in the treatment of patients with type I diabetes mellitus.
  
  
  BACKGROUND
  A striking improvement has taken place in the results of IIT with regard to attaining normoglycemia and insulin independence of type I diabetic recipients. Theoretically, this minimally invasive therapy should replace WOP because its risks and expense should be less. To date, however, no systematic comparisons of these 2 options have been reported.
  
  
  METHODS
  We conducted a retrospective analysis of a consecutive series of WOP and IIT performed at the University of Pennsylvania between September 2001 and February 2004. We compared a variety of parameters, including patient and graft survival, degree and duration of glucose homeostasis, procedural and immunosuppressive complications, and resources utilization.
  
  
  RESULTS
  Both WOP and IIT proved highly successful at establishing insulin independence in type I diabetic patients. Whole-organ pancreas recipients experienced longer lengths of stay, more readmissions, and more complications, but they exhibited a more durable state of normoglycemia with greater insulin reserves. Achieving insulin independence by IIT proved surprisingly more expensive, despite shorter initial hospital and readmission stays.
  
  
  CONCLUSIONS
  Despite recent improvement in the success of IIT, WOP provides a more reliable and durable restoration of normoglycemia. Although IIT was associated with less procedure-related morbidity and shorter hospital stays, we unexpectedly found IIT to be more costly than WOP. This was largely due to IIT requiring islets from multiple donors to gain insulin independence. Because donor pancreata that are unsuitable for WOP can often be used successfully for IIT, we suggest that as IIT evolves, it should continue to be evaluated as a complementary alternative to rather than as a replacement for the better-established method of WOP.
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Frank
authors.forename: Shaoping
authors.initials: S
authors.lastname: Deng
authors.forename: Xiaolun
authors.initials: X
authors.lastname: Huang
authors.forename: Ergun
authors.initials: E
authors.lastname: Velidedeoglu
authors.forename: Yong-Suk
authors.initials: YS
authors.lastname: Bae
authors.forename: Chengyang
authors.initials: C
authors.lastname: Liu
authors.forename: Peter
authors.initials: P
authors.lastname: Abt
authors.forename: Robert
authors.initials: R
authors.lastname: Stephenson
authors.forename: Muhammad
authors.initials: M
authors.lastname: Mohiuddin
authors.forename: Thav
authors.initials: T
authors.lastname: Thambipillai
authors.forename: Eileen
authors.initials: E
authors.lastname: Markmann
authors.forename: Maral
authors.initials: M
authors.lastname: Palanjian
authors.forename: Marty
authors.initials: M
authors.lastname: Sellers
authors.forename: Ali
authors.initials: A
authors.lastname: Naji
authors.forename: Clyde F
authors.initials: CF
authors.lastname: Barker
authors.forename: James F
authors.initials: JF
authors.lastname: Markmann
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D017048:Health Care Costs; D006295:Health Resources / Q000706:statistics & numerical data; D006706:Homeostasis; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007328:Insulin / Q000097:blood; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects / Q000191:economics; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000191:economics; D010359:Patient Readmission; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007328:Insulin