Transplantation for type I diabetes: comparison of vascularized whole-organ pancreas with isolated pancreatic islets.
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.
Frank
Adam
A
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Deng
Shaoping
S
Huang
Xiaolun
X
Velidedeoglu
Ergun
E
Bae
Yong-Suk
YS
Liu
Chengyang
C
Abt
Peter
P
Stephenson
Robert
R
Mohiuddin
Muhammad
M
Thambipillai
Thav
T
Markmann
Eileen
E
Palanjian
Maral
M
Sellers
Marty
M
Naji
Ali
A
Barker
Clyde F
CF
Markmann
James F
JF
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
D001786:Blood Glucose; D007328:Insulin