title: Risks and benefits of transplantation in the cure of type 1 diabetes: whole pancreas versus islet transplantation. A single center study.
abstract: 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.
  
  
  OBJECTIVE
  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: Diabetes Research Institute, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy. maffi.paola@hsr.it
authors: Paola
authors: P
authors: Maffi
authors: Marina
authors: M
authors: Scavini
authors: Carlo
authors: C
authors: Socci
authors: Lorenzo
authors: L
authors: Piemonti
authors: Rossana
authors: R
authors: Caldara
authors: Chiara
authors: C
authors: Gremizzi
authors: Raffaella
authors: R
authors: Melzi
authors: Rita
authors: R
authors: Nano
authors: Elena
authors: E
authors: Orsenigo
authors: Massimo
authors: M
authors: Venturini
authors: Carlo
authors: C
authors: Staudacher
authors: Alessandro
authors: A
authors: Del Maschio
authors: Antonio
authors: A
authors: Secchi
mesh_terms: D000293:Adolescent; D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007328:Insulin / Q000378:metabolism; D016381:Islets of Langerhans Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000379:methods*; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D007328:Insulin