Abstract
Whole-organ pancreas transplantation, either alone or combined with a kidney transplant, is the only definitive treatment for many patients with type 1 diabetes that restores normal glucose homoeostasis and insulin independence. Pancreas transplantation delays, or potentially prevents, secondary diabetes complications and is associated with improvement in patient survival when compared with either patients remaining on the waiting list or those receiving kidney transplant alone. Pancreas transplantation is safe and effective, with 1-year patient survival >97 % and graft survival rates of 85 % at 1 year and 76 % at 5 years in recent UK data. This review focuses on some current areas of interest in pancreas transplantation.
Similar content being viewed by others
References
Nathan DM (2015) Diabetes: advances in diagnosis and treatment. JAMA 314:1052
Patterson CC, Dahlquist GC et al (2009) Incidence trends for childhood type 1 diabetes in Europe during 1983–2993 and predicted new cases 2005–2020: a multicentre prospective registration study. Lancet 373:2027
Imperatore G, Boyle JP, SEARCH for Diabetes in Youth study group et al (2012) Projections of type 1 and type 2 diabetes burden in the US population aged <20 years through 2050. Diabetes Care 35:2515
American Diabetes Association (2013) Diabetes statistics. http://diabetes.org/diabetes-basics/diabetes-statistics/
Gregg E, Li Y et al (2014) Changes in diabetes-related complications in the United States, 1990–2010. N Engl J Med 370:1514
Preis SR, Hwang S-J et al (2009) Trends in all-cause and cardiovascular disease mortality among women and men with and without diabetes mellitus in the Framingham Heart Study, 1950–2005. Circulation 119:1728–1735
Livingstone SJ, Levin D et al (2015) Estimated life expectancy in a Scottish Cohort with type 1 diabetes, 2008–2010. JAMA 313:37
Gruessner RWG, Gruessner AC (2013) The current state of pancreas transplantation. Nat Rev Endocrinol 3:555
Redfield RR, Scalea JR, Odorico JS (2015) Simultaneous pancreas and kidney transplantation: current trends and future directions. Curr Opin Organ Transplant 20:94–102
Vaidya A, Muthusamy AS, Hadjianastassiou VG et al (2007) Simultaneous pancreas kidney transplantation: to anticoagulate or not? Is that a question? Clin Transplant 21:554–557
Gruessner AC, Gruessner RWG (2012) Pancreas transplant outcomes for the United States and non-United States cases as reported to the United Network for Organ Sharing and the International Pancreas transplant registry as of December 2011. Clin Transpl, p 23
Kandaswamy R, Skeans MA et al (2015) OPTN/SRTR 2013 annual data report: pancreas. Am J Transplant 15(S2):1–20
National Clinical Guideline Centre (UK) (2015) Type 1 diabetes in adults: type 1 diabetes in adults: diagnosis and management. National Institute for Health and Care Excellence (UK), London
Elwen FR, Huskinson A et al (2015) An observational study of patient characteristics and mortality following hypoglycemia in the community. BMJ Open Diabetes Res Care 3:e000094
Khunti K, Davies M et al (2015) Hypoglycemia and risk of cardiovascular disease and all-cause mortality in insulin-treated people with type 1 and type 2 diabetes: a cohort study. Diabetes Care 38:316
Groop PH, Thomas MC, FinnDiane Study Group et al (2009) The presence and severity of chronic kidney disease predicts all-cause mortality in type 1 diabetes. Diabetes 58:1651–1658
Rosolowsky ET, Skupien J et al (2011) Risk for ESRD in type 1 diabetes remains high despite renoprotection. J Am Soc Nephrol 22:545–553
Haapio M, Helve J et al (2010) Survival of patients with type 1 diabetes receiving renal replacement therapy 1980–2007. Diabetes Care 33:1718–1723
Rana A, Gruessner A et al (2015) Survival benefit of solid-organ transplant in the United States. JAMA Surg 150:252–259
Weiss AS, Smits G, Wiseman AC (2009) Simultaneous pancreas-kidney versus deceased donor kidney transplant: Can a fair comparison be made? Transplantation 87:1402–1410
Weiss AS, Smits G, Wiseman AC (2009) Twelve-month pancreas graft function significantly influences survival following simultaneous pancreas-kidney transplantation. Clin J Am Soc Nephrol 4:988–995
Wiseman AC, Huang E, Kamgar M, Bunnapradist S (2013) The impact of pre-transplant dialysis on simultaneous pancreas-kidney versus living donor kidney transplant outcomes. Nephrol Dial Transplant 28:1047–1058
Sung RS, Zhang M, Schaubel DE, Shu X, Magee JC (2015) A reassessment of the survival advantage of simultaneous kidney-pancreas versus kidney-alone transplantation. Transplantation 99:1900–1906
Kahn SE, Cooper ME, Del Prato S (2014) Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. Lancet 383:1068–1083
Covic AM, Schelling JR, Constantiner M, Iyengar SK, Sedor JR (2000) Serum C-peptide concentrations poorly phenotype type 2 diabetic end-stage renal disease patients. Kidney Int 58:1742–1750
Sasaki TM, Gray RS et al (1998) Successful long-term kidney-pancreas transplants in diabetic patients with high C-peptide levels. Transplantation 65:1510–1512
Wiseman AC, Gralla J (2012) Simultaneous pancreas kidney transplant versus other kidney transplant options in patients with type 2 diabetes. Clin J Am Soc Nephrol 7:656–664
Stratta RJ, Rogers J et al (2015) Pancreas transplantation in C-peptide positive patients: Does “type” of diabetes really matter? J Am Coll Surg 220:716–727
Ciancio G, Burke GW (2014) Type 2 diabetes: Is pancreas transplantation an option? Curr Diabetes Rep 14:542
Denecke C (2015) The bionic pancreas: novel perspectives on insulin replacement therapies. Transplantation 99:268–269
Russell SJ, El-Khatib FH et al (2014) Outpatient glycemic control with a bionic pancreas in type 1 diabetes. N Engl J Med 371:313–325
Fiorina P, Vezzulli P, Bassi R et al (2012) Near normalization of metabolic and functional features of the central nervous system in type 1 diabetic patients with end-stage renal disease after kidney-pancreas transplantation. Diabetes Care 35:367–374
Gremizzi C, Vergani A, Paloschi V, Secchi A (2010) Impact of pancreas transplantation on type 1 diabetes-related complications. Curr Opin Organ Transplant 15:119–123
Perseghin G, Fiorina P, De Cobelli F et al (2005) Cross-sectional assessment of the effect of kidney and kidney-pancreas transplantation on resting left ventricular energy metabolism in type 1 diabetic-uremic patients: a phosphorous-31 magnetic resonance spectroscopy study. J Am Coll Cardiol 46:1085–1092
Lindahl JP, Hartmann A, Aakhus S et al (2016) Long-term cardiovascular outcomes in type 1 diabetic patients after simultaneous pancreas and kidney transplantation compared with living donor kidney transplantation. Diabetologia 59:844–852
Dieterle CD, Arbogast H et al (2007) Metabolic follow-up after long term pancreas graft survival. Eur J Endocrinol 156:603–610
Pfeffer F, Nauck MA et al (2003) Postoperative oral glucose tolerance and stimulated insulin secretion: a predictor of endocrine graft function more than 10 years after pancreas kidney transplantation. Transplantation 76:1427–1431
Troppmann C, Gruessner AC et al (1996) Delayed endocrine pancreas graft function after simultaneous pancreas-kidney transplantation. Incidence, risk factors, and impact on long-term outcome. Transplantation 61:1323–1330
Mittal S, Nagendran M et al (2014) Postoperative impaired glucose tolerance is an early predictor of pancreas graft failure. Diabetologia 57:2076–2080
Mittal S, Franklin RH et al (2015) Early postoperative continuous glucose monitoring in pancreas transplant recipients. Transpl Int 28:604–609
Faradji RN, Froud T et al (2009) Long-term metabolic and hormonal effects of exenatide on islet transplant recipients with allograft dysfunction. Cell Transplant 18(10):1247–1259
Wang Y, Qi M et al (2013) Use of glucagon-like peptide-1 agonists to improve islet graft performance. Curr Diabetes Rep 13:723–732
Rickels MR, Naji A (2010) Reactive hypoglycaemia following GLP-1 infusion in pancreas transplant recipients. Diabetes Obes Metab 12:731
Lerche S, Soendergaard L (2009) No increased risk of hypoglycaemic episodes during 48h of subcutaneous glucagon-like-peptide-1 administration in fasting healthy subjects. Clin Endocrinol 71:500–506
Cariou B, Bernard C, Cantarovich D (2015) Liraglutide in whole-pancreas transplant patients with impaired glucose homoeostasis: a case series. Diabetes Metab 41:252–257
Dean PG, Kudva YC, Larson TS, Kremers WK, Stegall MD (2008) Post-transplant diabetes mellitus after pancreas transplantation. Am J Transplant 8(1):175–182
Vendrame F, Pileggi A et al (2010) Recurrence of type 1 diabetes after simultaneous pancreas-kidney transplantation, despite immunosuppression, is associated with autoantibodies and pathogenic autoreactive CD4 T-cells. Diabetes 59:947–957
Ishida-Oku M, Iwase M et al (2010) A case of recurrent type 1 diabetes mellitus with insulitis of transplanted pancreas in simultaneous pancreas-kidney transplantation from cardiac death donor. Diabetologia 53:341–345
Braghi S, Bonifacio E, Secchi A, Di Carlo V, Pozza G, Bosi E (2000) Modulation of humoral islet autoimmunity by pancreas allotransplantation influences allograft outcome in patients with type 1 diabetes. Diabetes 49:218–224
Vendrame F, Hopfner YY et al (2016) Risk factors for type 1 diabetes recurrence in immunosuppressed recipients of simultaneous pancreas-kidney transplants. Am J Transplant 16:235–245
Mittal S, Page SL, Friend PJ, Sharples EJ, Fuggle SV (2014) De novo donor-specific HLA antibodies: biomarkers of pancreas transplant failure. Am J Transplant 14:1664–1671
Drachenberg CB, Papadimitriou JC (2007) Spectrum of histopathological changes in pancreas allograft biopsies and relationship to graft loss. Transplant Proc 39:2326–2328
Papadimitriou JC, Drachenberg CB (2012) Distinctive morphological features of antibody-mediated and T-cell-mediated acute rejection in pancreas allograft biopsies. Curr Opin Organ Transplant 17:93–99
León Fradejas M, Kandil D et al (2015) Islet amyloid in whole pancreas transplants for type 1 diabetes mellitus (DM): possible role of type 2 DM for graft failure. Am J Transplant 15:2495–2500
OPTN/UNOS pancreas transplant committee report to committee June 2015. http://optn.transplant.hrsa.gov/converge/CommitteeReports/board_main_PancreasTransplantationCommittee_6_3_2015_18_15.pdf
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Human and animal rights
This article does not contain any studies with human or animal subjects performed by the any of the authors.
Informed consent
For this type of study, informed consent is not required.
Additional information
Managed by Antonio Secchi.
Rights and permissions
About this article
Cite this article
Sharples, E.J., Mittal, S.M. & Friend, P.J. Challenges in pancreas transplantation. Acta Diabetol 53, 871–878 (2016). https://doi.org/10.1007/s00592-016-0865-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00592-016-0865-x