Prevention and management of hyperglycemia after pancreas transplantation.
OBJECTIVE
Pancreas transplantation is considered the optimal therapy for patients with insulin-dependent diabetes. Successful pancreas transplantation achieves euglycemia and allows freedom from insulin therapy. Long-term allograft success may be limited by the development of impaired glucose metabolism. The objectives of the present review are to summarize the possible reasons for endocrine pancreatic dysfunction and to focus on its prevention and management and emphasize the role of immunosuppression.


RESULTS
The diabetogenic effects of current immunosuppressive agents have been well established. Regimens without corticosteroids and calcineurin-inhibitor minimization or avoidance have been promoted. Recent studies have revisited the pathogenesis of type I and type II diabetes and demonstrated common pathways, including apoptosis induction, for the exhaustion and destruction of the pancreatic islets.


CONCLUSIONS
The immunosuppressive regimens in pancreatic transplantation should be designed and appropriately modified according to the graft immunological and metabolic conditions. New molecules that are able to preserve islet function and maintain optimal insulin secretion should be considered for pancreas transplant recipients.
Egidi
M Francesca
MF
Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina 29425, USA. egidi@musc.edu
Lin
Angello
A
Bratton
Charles F
CF
Baliga
Prabhakar K
PK
D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016035:Pancreas Transplantation / Q000009:adverse effects*
D007166:Immunosuppressive Agents