Current Diabetes Reports

, Volume 12, Issue 5, pp 587–596 | Cite as

Recovery of Endocrine Function After Islet and Pancreas Transplantation

Transplantation (A Pileggi, Section Editor)

Abstract

Long-standing type 1 diabetes (T1D) is associated with an absolute loss of endogenous insulin secretion (circulating C-peptide is undetectable) and a related defect in glucose counter-regulation that is often complicated by hypoglycemia unawareness, markedly increasing the risk for severe hypoglycemia. Both the transplantation of isolated islets and a whole pancreas can restore β-cell secretory capacity, improve glucose counter-regulation, and return hypoglycemia awareness, thus alleviating severe hypoglycemia. The transplantation of islets may require more than one donor pancreas, and the recovery of endocrine function for now appears more durable with a whole pancreas; however, islet transplantation outcomes are steadily improving. Because not all patients with T1D experiencing severe hypoglycemia are candidates to receive a whole pancreas, and since not all pancreata are technically suitable for whole organ transplantation, islet and pancreas transplantation are evolving as complementary approaches for the recovery of endocrine function in patients with the most problematic T1D.

Keywords

Type 1 diabetes C-peptide response Functional β-cell mass β-cell secretory capacity Insulin secretion Insulin sensitivity Proinsulin secretion Glucagon secretion Glucose counter-regulation Hypoglycemia unawareness Immunosuppression drugs Prednisone Tacrolimus Sirolimus Mycophenolate Endocrine function Islet and pancreas transplantation 

Notes

Acknowledgments

This work was supported in part by Public Health Service grants R01-DK091331 (to M.R.R.) and U01-DK070430 (Penn Clinical Islet Transplantation Center) from the National Institutes of Health, the Pennsylvania State Department of Health (Penn Center of Excellence for Regenerative Medicine), and the Schiffrin Award for research in autoimmune disorders at the University of Pennsylvania (to M.R.R.).

Disclosure

Conflicts of interest: M. R. Rickles: was a Scientific Advisory Board Member, 2011, for Schulze Diabetes Institute, University of Minnesota.

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© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Medicine, Division of Endocrinology, Diabetes, and MetabolismPerelman School of Medicine at the University of Pennsylvania, Institute for Diabetes, Obesity, and MetabolismPhiladelphiaUSA

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