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Patient Selection: Pancreas or Islet Transplantation

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Transplantation of the Pancreas

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Abstract

Beta-cell transplantation offers a viable option to insulin-based therapy for suitable diabetic patients with or without advanced kidney disease. The early benefits of beta-cell transplants are the restoration of euglycemia and freedom from severe hypoglycemic events (SHE). Improvements in vascular complications of diabetes mellitus provide long-term benefits. These benefits have to be weighed against the procedural and immunosuppression risks associated with beta-cell transplantation. The two types of beta-cell transplants, whole-organ pancreas and islet, vary vastly in techniques and desired outcomes. Whole-organ pancreas transplant achieves freedom from SHE and insulin-independence in the majority of recipients, but entails a major surgical procedure with higher rates of complications. On the other hand, islet transplantation is a minimally invasive procedure with fewer procedure-related complications providing freedom from SHE but low rates of sustained insulin-independence. Thus, pancreas transplantation is more suitable for younger healthier recipients seeking insulin-independence, and islet transplantation is better suited for older patients by minimizing procedural risks. The risks of immunosuppressive medication are most relevant for patients undergoing pancreas or islet transplantation alone rather than beta-cell transplant in patients with simultaneous or after a kidney transplant. Islet transplantation is offered solely to type 1 diabetes mellitus, while certain type 2 diabetes may be candidates for pancreas transplantation along with kidney transplantation. Patient preferences and perceptions should be incorporated into the decision making for the type of transplant. Despite improving outcomes in both pancreas and islet transplantation, beta-cell therapies face major hurdles of insurance coverage (islet transplantation) and widespread acceptance (pancreas transplantation alone) in the United States, which are often the limiting factor for access to beta-cell transplant.

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References

  1. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2020.

    Google Scholar 

  2. Diabetes C, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977–86.

    Article  Google Scholar 

  3. Nathan DM, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005;353(25):2643–53.

    Article  PubMed  Google Scholar 

  4. Lind M, et al. Glycemic control and excess mortality in type 1 diabetes. N Engl J Med. 2014;371(21):1972–82.

    Article  PubMed  Google Scholar 

  5. Tancredi M, et al. Excess mortality among persons with type 2 diabetes. N Engl J Med. 2015;373(18):1720–32.

    Article  CAS  PubMed  Google Scholar 

  6. Robertson RP, et al. Pancreas and islet transplantation in type 1 diabetes. Diabetes Care. 2006;29(4):935.

    Article  PubMed  Google Scholar 

  7. Choudhary P, et al. Evidence-informed clinical practice recommendations for treatment of type 1 diabetes complicated by problematic hypoglycemia. Diabetes Care. 2015;38(6):1016–29.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Stratta R, Gruessner AC, Gruessner RW. The past, present, and future of pancreas transplantation for diabetes mellitus. Endocrinol Diabetes Metab J. 2018;2(3):1–9.

    Google Scholar 

  9. Tenth Annual Report of the Collaborative Islet Transplant Registry. 2017 Jan 6. Available at http://www.citregistry.org. 2 Jan 2021.

  10. Pancreas Transplant Centers in the United States. [Cited 2021 Jan 2]; Available from: https://www.srtr.org/transplant-centers/?organ=pancreas.

  11. Islet Transplant Centers in the United States. [Cited 2021 Jan 2]. Available from: https://citregistry.org/na-islet-transplant-centers.

  12. Maffi P, Secchi A. Islet transplantation alone versus solitary pancreas transplantation: an outcome-driven choice? Curr Diab Rep. 2019;19(5):26.

    Article  PubMed  Google Scholar 

  13. Gala-Lopez BL, Pepper AR, Shapiro AM. Pancreas versus islets after a successful kidney transplant. Curr Transpl Rep. 2014;1:124–35.

    Article  Google Scholar 

  14. Classification of diabetes mellitus. Geneva: World Health Organization; Licence: CC BY-NC-SA 3.0 IGO; 2019.

    Google Scholar 

  15. Gruessner AC, et al. Simultaneous pancreas and kidney transplantation-is it a treatment option for patients with type 2 diabetes mellitus? An analysis of the international pancreas transplant registry. Curr Diab Rep. 2017;17(6):44.

    Article  PubMed  Google Scholar 

  16. Organ procurement and transplantation network; kidney-pancreas allocation system frequently asked questions. 2014. [Cited 2021 Jan 2]. Available from: https://optn.transplant.hrsa.gov/resources/guidance/kidney-pancreas-allocation-system-frequently-asked-questions/.

  17. Organ procurement and transplantation network; policy 11; 253–260; effective. 2020 Dec 6. 2020 [cited 2021 Jan 2]. Available from: https://optn.transplant.hrsa.gov/media/1200/optn_policies.pdf.

  18. Kandaswamy R, et al. OPTN/SRTR 2018 annual data report: pancreas. Am J Transplant. 2020;20(Suppl 1):131–92.

    Article  PubMed  Google Scholar 

  19. Gruessner RW, Gruessner AC. Pancreas after islet transplantation: a first report of the international pancreas transplant registry. Am J Transplant. 2016;16(2):688–93.

    Article  CAS  PubMed  Google Scholar 

  20. Usatin DJ, et al. Under utilization of pancreas transplants in cystic fibrosis recipients in the united network organ sharing (unos) data 1987–2014. Am J Transplant. 2016;16(5):1620–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Rickels MR, Robertson RP. Pancreatic islet transplantation in humans: recent progress and future directions. Endocr Rev. 2019;40(2):631–68.

    Article  PubMed  Google Scholar 

  22. Kandaswamy R, Sutherland DE. Pancreas versus islet transplantation in diabetes mellitus: how to allocate deceased donor pancreata? Transplant Proc. 2006;38(2):365–7.

    Article  CAS  PubMed  Google Scholar 

  23. Siskind E, et al. Pancreas transplantation from donors after cardiac death: an update of the UNOS database. Pancreas. 2014;43(4):544–7.

    Article  PubMed  Google Scholar 

  24. Axelrod DA, et al. Systematic evaluation of pancreas allograft quality, outcomes and geographic variation in utilization. Am J Transplant. 2010;10(4):837–45.

    Article  CAS  PubMed  Google Scholar 

  25. Agarwal A, Brayman KL. Update on islet transplantation for type 1 diabetes. Semin Intervent Radiol. 2012;29(2):90–8.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Balamurugan AN, et al. Islet product characteristics and factors related to successful human islet transplantation from the collaborative islet transplant registry (CITR) 1999–2010. Am J Transplant. 2014;14(11):2595–606.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Hering BJ, et al. Phase 3 trial of transplantation of human islets in type 1 diabetes complicated by severe hypoglycemia. Diabetes Care. 2016;39(7):1230–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Ricordi C, et al. National Institutes of Health-sponsored clinical islet transplantation consortium phase 3 trial: manufacture of a complex cellular product at eight processing facilities. Diabetes. 2016;65(11):3418–28.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Chow VC, et al. Diabetic retinopathy after combined kidney-pancreas transplantation. Clin Transpl. 1999;13(4):356–62.

    Article  CAS  Google Scholar 

  30. Pearce IA, et al. Stabilisation of diabetic retinopathy following simultaneous pancreas and kidney transplant. Br J Ophthalmol. 2000;84(7):736–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Fioretto P, et al. Reversal of lesions of diabetic nephropathy after pancreas transplantation. N Engl J Med. 1998;339(2):69–75.

    Article  CAS  PubMed  Google Scholar 

  32. Boggi U, et al. Long-term (5 years) efficacy and safety of pancreas transplantation alone in type 1 diabetic patients. Transplantation. 2012;93(8):842–6.

    Article  CAS  PubMed  Google Scholar 

  33. Coppelli A, et al. The beneficial effects of pancreas transplant alone on diabetic nephropathy. Diabetes Care. 2005;28(6):1366–70.

    Article  PubMed  Google Scholar 

  34. Navarro X, Sutherland DE, Kennedy WR. Long-term effects of pancreatic transplantation on diabetic neuropathy. Ann Neurol. 1997;42(5):727–36.

    Article  CAS  PubMed  Google Scholar 

  35. La Rocca E, et al. Cardiovascular outcomes after kidney-pancreas and kidney-alone transplantation. Kidney Int. 2001;60(5):1964–71.

    PubMed  Google Scholar 

  36. Fiorina P, et al. Islet transplantation improves vascular diabetic complications in patients with diabetes who underwent kidney transplantation: a comparison between kidney-pancreas and kidney-alone transplantation. Transplantation. 2003;75(8):1296–301.

    Article  PubMed  Google Scholar 

  37. Casey JJ, et al. Portal venous pressure changes after sequential clinical islet transplantation. Transplantation. 2002;74(7):913–5.

    Article  CAS  PubMed  Google Scholar 

  38. Cardani R, et al. Allosensitization of islet allograft recipients. Transplantation. 2007;84(11):1413–27.

    Article  PubMed  Google Scholar 

  39. Rios P, et al. Persistence of allosensitization after islet allograft failure. Diabetes. 2018;67(Suppl 1).

    Google Scholar 

  40. Alejandro R. Prevention of de novo allosensitization in islet transplant recipients following complete graft loss; ClinicalTrials.gov Identifier: NCT01999361. [Cited 2021 Jan 2]. Available from: https://clinicaltrials.gov/ct2/show/NCT01999361.

  41. Naziruddin B, et al. HLA class I sensitization in islet transplant recipients: report from the Collaborative Islet Transplant Registry. Cell Transplant. 2012;21(5):901–8.

    Article  PubMed  Google Scholar 

  42. Chaigne B, et al. Immunogenicity of anti-HLA antibodies in pancreas and islet transplantation. Cell Transplant. 2016;25(11):2041–50.

    Article  PubMed  Google Scholar 

  43. Shapiro AM, et al. Islet transplantation in seven patients with type 1 diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. N Engl J Med. 2000;343(4):230–8.

    Article  CAS  PubMed  Google Scholar 

  44. Organ procurement and transplantation network: proposal for the definition of pancreas graft failure. 2014. [Cited 2021 Jan 2]. Available from: https://optn.transplant.hrsa.gov/media/1116/03_pa_graft_failure_definition.pdf.

  45. Barton FB, et al. Improvement in outcomes of clinical islet transplantation: 1999-2010. Diabetes Care. 2012;35(7):1436–45.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Forbes S, et al. Validation of the BETA-2 score: an improved tool to estimate beta cell function after clinical islet transplantation using a single fasting blood sample. Am J Transplant. 2016;16(9):2704–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Tan J, et al. Simultaneous islet and kidney transplantation in seven patients with type 1 diabetes and end-stage renal disease using a glucocorticoid-free immunosuppressive regimen with alemtuzumab induction. Diabetes. 2008;57(10):2666–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Gerber PA, et al. Simultaneous islet-kidney vs pancreas-kidney transplantation in type 1 diabetes mellitus: a 5 year single centre follow-up. Diabetologia. 2008;51(1):110–9.

    Article  CAS  PubMed  Google Scholar 

  49. Lehmann R, et al. Glycemic control in simultaneous islet-kidney versus pancreas-kidney transplantation in type 1 diabetes: a prospective 13-year follow-up. Diabetes Care. 2015;38(5):752–9.

    Article  CAS  PubMed  Google Scholar 

  50. Fridell JA, et al. The survival advantage of pancreas after kidney transplant. Am J Transplant. 2019;19(3):823–30.

    Article  PubMed  Google Scholar 

  51. Toso C, et al. Sequential kidney/islet transplantation: efficacy and safety assessment of a steroid-free immunosuppression protocol. Am J Transplant. 2006;6(5 Pt 1):1049–58.

    Article  CAS  PubMed  Google Scholar 

  52. Deng S, et al. Islet alone versus islet after kidney transplantation: metabolic outcomes and islet graft survival. Transplantation. 2009;88(6):820–5.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Kaufman DB, et al. Sequential kidney/islet transplantation using prednisone-free immunosuppression. Am J Transplant. 2002;2(7):674–7.

    Article  CAS  PubMed  Google Scholar 

  54. Vantyghem MC, et al. Ten-year outcome of islet alone or islet after kidney transplantation in type 1 diabetes: a prospective parallel-arm cohort study. Diabetes Care. 2019;42(11):2042–9.

    Article  PubMed  Google Scholar 

  55. Cure P, et al. Improved metabolic control and quality of life in seven patients with type 1 diabetes following islet after kidney transplantation. Transplantation. 2008;85(6):801–12.

    Article  CAS  PubMed  Google Scholar 

  56. Moassesfar S, et al. A comparative analysis of the safety, efficacy, and cost of islet versus pancreas transplantation in nonuremic patients with type 1 diabetes. Am J Transplant. 2016;16(2):518–26.

    Article  CAS  PubMed  Google Scholar 

  57. Posselt AM, et al. Islet transplantation in type 1 diabetics using an immunosuppressive protocol based on the anti-LFA-1 antibody efalizumab. Am J Transplant. 2010;10(8):1870–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Posselt AM, et al. Islet transplantation in type 1 diabetic patients using calcineurin inhibitor-free immunosuppressive protocols based on T-cell adhesion or costimulation blockade. Transplantation. 2010;90(12):1595–601.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Mujtaba MA, et al. Conversion from tacrolimus to belatacept to prevent the progression of chronic kidney disease in pancreas transplantation: case report of two patients. Am J Transplant. 2014;14(11):2657–61.

    Article  CAS  PubMed  Google Scholar 

  60. Stratta RJ, et al. Pancreas transplantation: an alarming crisis in confidence. Am J Transplant. 2016;16(9):2556–62.

    Article  CAS  PubMed  Google Scholar 

  61. OPTN/UNOS briefing paper: broadened allocation of pancreas transplants across compatible ABO blood types. 2017. [Cited 2021 Jan 2]. Available from: https://optn.transplant.hrsa.gov/media/2335/pancreas_boardreport_201712.pdf.

  62. Notice of OPTN policy changes: eliminate the use of DSA and region from pancreas allocation policy. [Cited 2021 Jan 2]. Available from: https://optn.transplant.hrsa.gov/media/3453/pancreas-removal-of-dsa-policy-notice.pdf.

  63. National Coverage Determination (NCD) for islet transplantation in the context of a clinical trial (260.3.1); 2014. [Cited 2021 Jan 2]. Available from: https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=286&ncdver=1&bc=AgAAQAAAAAAA&.

  64. Bottino R, et al. The future of islet transplantation is now. Front Med (Lausanne). 2018;5:202.

    Article  PubMed  Google Scholar 

  65. Ricordi C, Japour A. Transplanting islet cells can fix brittle diabetes. Why isn’t it available in the U.S.? CellR4. 2019;7:e2768.

    Google Scholar 

  66. Berney T. Not reimbursing islet transplantation creates discrimination against patients with type 1 diabetes. CellR4. 2019;7:e2774.

    Google Scholar 

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Authors and Affiliations

  1. University of Virginia, Charlottesville, VA, USA

    Swati Rao & Meaghan Stumpf

  2. Medicine and Biomedical Engineering, Kidney, Pancreas and Islet Transplant Programs, Center for Cellular Therapy and Biologic Therapeutics, University of Virginia, Charlottesville, VA, USA

    Kenneth L. Brayman

Authors
  1. Swati Rao
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  2. Meaghan Stumpf
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  3. Kenneth L. Brayman
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Correspondence to Kenneth L. Brayman .

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Editors and Affiliations

  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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Rao, S., Stumpf, M., Brayman, K.L. (2023). Patient Selection: Pancreas or 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_18

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  • DOI: https://doi.org/10.1007/978-3-031-20999-4_18

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