title: The current state of pancreas transplantation.
abstract: For many patients with type 1 diabetes mellitus and selected patients with type 2 diabetes mellitus, a successful pancreas transplant is the only definitive long-term treatment that both restores euglycaemia without the risk of severe hypoglycaemia and prevents, halts or reverses secondary complications. These benefits come at the cost of major surgery and lifelong immunosuppression. Nevertheless, pancreas transplants are safe and effective, with patient survival rates currently >95% at 1 year and >88% at 5 years; graft survival rates are almost 85% at 1 year and >60% at 5 years. The estimated half-life of a pancreas graft is now 7-14 years. The improvements in graft survival are attributable to considerable reductions in technical failures and in immunologic graft losses. Pancreas recipients have reduced mortality compared with waiting candidates or patients with diabetes mellitus who undergo a kidney transplant alone. Pancreas transplants should be more frequently offered to nonuraemic patients with brittle diabetes mellitus to prevent the development of secondary diabetic complications and to avoid the need for a kidney transplant. Although the results of islet transplantation have also improved, islet recipients rarely maintain long-term insulin independence despite the use of multiple organ donor pancreases. Pancreas transplants and islet transplants should be considered complementary, not mutually exclusive, procedures that are chosen on the basis of the individual patient's surgical risk.
authors.affiliation: Department of Surgery, University of Arizona, 1501 N. Campbell Avenue, Room 4410, PO Box 245066, Tucson, AZ 85724, USA. rgruessner@ surgery.arizona.edu
authors.forename: Rainer W G
authors.initials: RW
authors.lastname: Gruessner
authors.forename: Angelika C
authors.initials: AC
authors.lastname: Gruessner
mesh_terms: D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D003924:Diabetes Mellitus, Type 2 / Q000601:surgery; D005260:Female; D006801:Humans; D016381:Islets of Langerhans Transplantation / Q000379:methods; D008297:Male; D016035:Pancreas Transplantation / Q000379:methods*; D016896:Treatment Outcome
references.citation: Diabetes Care. 2002 May;25(5):906-11
references.pmid: 11978689
references.citation: N Engl J Med. 1990 Apr 12;322(15):1031-7
references.pmid: 2320063
references.citation: Diabetologia. 2006 Dec;49(12):2977-82
references.pmid: 17021920
references.citation: Transplantation. 2005 May 27;79(10):1296-7
references.pmid: 15912092
references.citation: N Engl J Med. 2007 May 3;356(18):1842-52
references.pmid: 17476010
references.citation: Transpl Int. 2005 Sep;18(9):1054-60
references.pmid: 16101726
references.citation: Clin Transplant. 2009 Mar-Apr;23(2):199-205
references.pmid: 19220365
references.citation: Diabetologia. 2006 Feb;49(2):298-305
references.pmid: 16365724
references.citation: N Engl J Med. 2000 Feb 10;342(6):381-9
references.pmid: 10666428
references.citation: N Engl J Med. 1993 Sep 30;329(14):977-86
references.pmid: 8366922
references.citation: Am J Kidney Dis. 2003 Feb;41(2):464-70
references.pmid: 12552511
references.citation: Diabetes Care. 2000 Dec;23(12):1804-10
references.pmid: 11128357
references.citation: Cell Transplant. 2000 Nov-Dec;9(6):903-8
references.pmid: 11202576
references.citation: Ann Surg. 2001 Nov;234(5):689-96
references.pmid: 11685034
references.citation: Transplantation. 2008 Jan 15;85(1):42-7
references.pmid: 18192910
references.citation: Curr Opin Organ Transplant. 2012 Feb;17(1):100-5
references.pmid: 22186094
references.citation: Surgery. 1967 Jun;61(6):827-37
references.pmid: 5338113
references.citation: Transplantation. 2011 Oct 15;92(7):802-8
references.pmid: 21822170
references.citation: Transplant Proc. 1995 Dec;27(6):3072
references.pmid: 8539848
references.citation: Transplantation. 2003 Sep 27;76(6):974-6
references.pmid: 14508364
references.citation: Rev Diabet Stud. 2011 Spring;8(1):44-50
references.pmid: 21720672
references.citation: Diabetes Care. 2004 Jul;27(7):1706-11
references.pmid: 15220250
references.citation: Trans Assoc Am Physicians. 1984;97:80-7
references.pmid: 6398950
references.citation: Diabetes Care. 2007 Mar;30(3):597-603
references.pmid: 17327327
references.citation: Kidney Int. 2001 Nov;60(5):1964-71
references.pmid: 11703616
references.citation: Transplantation. 1995 Apr 27;59(8):1105-12
references.pmid: 7732555
references.citation: N Engl J Med. 1988 Jan 28;318(4):208-14
references.pmid: 3275895
references.citation: Clin Transpl. 2012;:23-40
references.pmid: 23721008
references.citation: Diabetologia. 1997 Sep;40(9):1110-2
references.pmid: 9300250
references.citation: Transplantation. 2001 Jan 15;71(1):82-90
references.pmid: 11211201
references.citation: J Am Coll Surg. 2008 Mar;206(3):458-65
references.pmid: 18308216
references.citation: Am J Transplant. 2012 Jun;12(6):1576-83
references.pmid: 22494609
references.citation: N Engl J Med. 2006 Sep 28;355(13):1318-30
references.pmid: 17005949
references.citation: Endocr Pract. 1999 Jan-Feb;5(1):24-8
references.pmid: 15251699
references.citation: N Engl J Med. 1998 Jul 9;339(2):69-75
references.pmid: 9654536
references.citation: Eur J Endocrinol. 2007 May;156(5):603-10
references.pmid: 17468197
references.citation: Diabetes Care. 2012 Jul;35(7):1436-45
references.pmid: 22723582
references.citation: Am J Transplant. 2004 Dec;4(12):2018-26
references.pmid: 15575904
references.citation: Diabetes. 2005 Nov;54(11):3205-11
references.pmid: 16249446
references.citation: Transplantation. 1992 Dec;54(6):992-6
references.pmid: 1465793
references.citation: Diabetes Care. 2012 Feb;35(2):367-74
references.pmid: 22190674
references.citation: Diabetologia. 1991 Aug;34 Suppl 1:S145-9
references.pmid: 1936683
references.citation: Clin Transplant. 1998 Jun;12(3):233-42
references.pmid: 9642516
references.citation: Am J Transplant. 2012 Aug;12(8):2150-6
references.pmid: 22845910
references.citation: Clin Transplant. 2009 Aug-Sep;23(4):437-46
references.pmid: 19496790
references.citation: N Engl J Med. 2000 Jul 27;343(4):230-8
references.pmid: 10911004
references.citation: Lancet. 2003 Oct 11;362(9391):1242
references.pmid: 14568760
references.citation: PLoS One. 2010 Mar 29;5(3):e9923
references.pmid: 20360867
references.citation: J Nephrol. 2012 Jan-Feb;25(1):13-8
references.pmid: 22241641
references.citation: Kidney Int. 2000 May;57(5):2129-35
references.pmid: 10792634
references.citation: Ann Neurol. 1997 Nov;42(5):727-36
references.pmid: 9392572
references.citation: Curr Diab Rep. 2012 Oct;12(5):587-96
references.pmid: 22763730
references.citation: Clin Transplant. 1992 Jun;6(3 part 1):165-71
references.pmid: 10147929
references.citation: Diabetes Care. 2005 Apr;28(4):866-72
references.pmid: 15793187
references.citation: Am J Transplant. 2008 Oct;8(10):1990-7
references.pmid: 18828765
references.citation: Transplantation. 2002 Mar 27;73(6):936-40
references.pmid: 11923696
references.citation: Clin Transpl. 2003;:21-51
references.pmid: 15387096
references.citation: Transpl Int. 2005 May;18(5):619-22
references.pmid: 15819813
references.citation: Lancet. 1999 Jun 5;353(9168):1915-9
references.pmid: 10371569
references.citation: Kidney Int. 2006 Mar;69(5):907-12
references.pmid: 16518350
references.citation: JAMA. 2003 Dec 3;290(21):2817-23
references.pmid: 14657065
references.citation: Diabetes Care. 1995 Jan;18(1):93-5
references.pmid: 7698056
references.citation: Arch Surg. 1997 Apr;132(4):358-61; discussion 361-2
references.pmid: 9108755
references.citation: J Am Soc Nephrol. 2001 Nov;12(11):2490-2499
references.pmid: 11675427
references.citation: Diabetes. 1989 Jan;38 Suppl 1:40-2
references.pmid: 2642856
references.citation: Diabetologia. 2007 Dec;50(12):2439-42
references.pmid: 17901942
references.citation: Dig Dis. 1991;9(6):437-43
references.pmid: 1804583