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Secondary Complications: Pancreas Versus Islet Transplantation

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Transplantation of the Pancreas

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Abstract

Follow-up studies after pancreas and islet transplantation have shown that these transplants can improve or worsen the development and progression of secondary diabetic complications. A favorable outcome has been noted during the initial stages of retinopathy in islet transplant recipients; there has also been a lack of progression of neuropathy and macroangiopathy following both pancreas and islet transplantation. While a beneficial long-term effect of pancreas transplantation on native and transplanted kidney function is well documented, the effect of islet transplantation is still less clear due to shorter follow-up and the use of more nephrotoxic immunosuppressants; the change from combined tacrolimus–sirolimus after islet transplantation as per the original Edmonton protocol to tacrolimus–mycophenolate mofetil maintenance therapy has improved kidney function. In islet transplantation, it has been shown that despite the absence of insulin independence, a favorable impact on secondary complications can be observed in the presence of C-peptide secretion. The limitations of studies comparing the impact of pancreas versus islet transplantation on secondary complications include the small numbers of subjects, the lack of randomized trials, and the complexity of comparisons with appropriate control groups. However, it is evident that stable glycemic control and restoration of even some partial endocrine function (i.e., C-peptide secretion in the presence of exogenous insulin administration after islet transplantation) have a positive impact on secondary diabetic complications.

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Authors and Affiliations

  1. Internal Medicine and Transplant Unit, Vita Salute University—San Raffaele, Scientific Institute Ospedale San Raffaele, Milan, Italy

    Paola Maffi, Davide Catarinella & Antonio Secchi

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  1. Paola Maffi
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  2. Davide Catarinella
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  3. Antonio Secchi
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Correspondence to Paola Maffi .

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  1. Department of Surgery, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USA

    Rainer W. G. Gruessner

  2. Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA

    Angelika C. Gruessner

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Maffi, P., Catarinella, D., Secchi, A. (2023). Secondary Complications: Pancreas Versus Islet Transplantation. In: Gruessner, R.W.G., Gruessner, A.C. (eds) Transplantation of the Pancreas. Springer, Cham. https://doi.org/10.1007/978-3-031-20999-4_64

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