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Pancreas vs. Islet Transplantation: the False Dilemma

  • Cellular Transplants (G Orlando, Section Editor)
  • Published:
Current Transplantation Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Pancreas and islet cell transplantation are the only treatment modalities that can restore euglycemia and allow freedom from hypoglycemic events. Transplantation for diabetes has decreased in the USA over the last 6 years due to several factors. Reasons for this and possible future paths will be explored.

Recent Findings

Clinical application of islet transplantation is mostly limited by regulatory hurdles in the USA. The limitations of pancreas transplantation are multifactorial and more nuanced. Both types of transplants are limited by the number of suitable organ donors; however, pancreas and islet transplantation do not compete for the same organs. Only 10.7% of available pancreata are currently being utilized for clinical application.

Summary

Current technology if utilized more efficiently could significantly increase the available donor pancreata for both whole organ and islets. Considering that severely diseased pancreata are routinely processed for islets and subsequent transplanted in chronic pancreatitis patients, and have significant metabolic impact in these patients, there is an opportunity to widen the organ use beyond what is currently done. Optimizing access to β-cell replacement therapy has significant potential to improve outcomes for carefully selected patients.

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Abbreviations

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

BLA:

Biological License Application

BMI:

Body mass index

BUN:

Blood urea nitrogen

CITR:

Collaborative Islet Transplant Registry

CIT Consortium:

Clinical Islet Transplant Consortium

DBD:

Donation after brain death

DCD:

Donation after circulatory death

HbA1c:

Glycated hemoglobin

IAK:

Islet transplant after kidney transplant

IPTR:

International Pancreas Transplant Registry

IS:

Immunosuppression

ITA:

Islet transplant alone

OPTN:

Organ Procurement and Transplantation Network

PAK:

Pancreas after kidney transplant

PDRI:

Pancreas donor risk index

PTA:

Pancreas transplant alone

SPK:

Simultaneous pancreas kidney transplant

SRTR:

Scientific Registry of Transplant Recipients

T1DM:

Type 1 diabetes mellitus

T2DM:

Type 2 diabetes mellitus

UW:

University of Wisconsin

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Acknowledgments

I thank Dr. Abhinav Humar, University of Pittsburgh Medical Center, for the critical review of the manuscript; Christine Burr, University of Pittsburgh, for the editorial review; and Dr. Rita Bottino, University of Pittsburgh, for the critical review and for providing photo micrographs of human islets.

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Authors and Affiliations

  1. Department of Surgery, Division of Transplantation, University of Pittsburgh, 200 Lothrop Street, MUH 7 South, Pittsburgh, PA, 15213, USA

    Martin Wijkstrom

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Correspondence to Martin Wijkstrom.

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Wijkstrom, M. Pancreas vs. Islet Transplantation: the False Dilemma. Curr Transpl Rep 7, 230–236 (2020). https://doi.org/10.1007/s40472-020-00299-7

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