J Korean Med Assoc.  2008 Aug;51(8):724-731. 10.5124/jkma.2008.51.8.724.

Pancreas and Islet Transplantation in Diabetes

Affiliations
  • 1Department of Sugery, University of Ulsan College of Medicine, Korea. djhan@amc.seoul.kr

Abstract

Bcell replacement, either by the intact whole pancreas or by an isolated pancreas islet, has become a clinical option to be considered in the treatment of patients with type 1 insulindependent diabetes mellitus or some of type 2 diabetes. Between the two treatment options, the pancreas transplantation has been shown to be very effective at maintaining an euglycemic state for a sustained period of time providing the recipient with a normal life. The graft survival has been improved due to a current combination of immunosuppressants, refined surgical techniques, and a better postoperative patient care. However, it is associated with a risk of surgical and postoperative complications. The islet transplantation has been considered to be an attractive treatment modality as a less invasive and easily applicable procedure in lieu of whole organ pancreas transplantation. In spite of its many advantages, the islet transplantation has not always achieved the sustained level of normoglycemia without insulin. A poor early or long term graft survival is considered to be caused by inconsistent low islet yield, initial considerable amount of graft loss during engraftment period, rejection of islet in hepatic environment, and absence of monitoring tool for islet graft function. Although current clinical reports have led to a promising result, further improvements are needed to get the long term successful results. Now the current status of pancreas and islet transplantations is reviewed and perspectives of these treatments are discussed.

Keyword

Pancreas transplantation; Islet transplantation; Diabetes

MeSH Terms

Diabetes Mellitus
Graft Survival
Humans
Immunosuppressive Agents
Insulin
Islets of Langerhans Transplantation
Pancreas
Pancreas Transplantation
Patient Care
Postoperative Complications
Rejection (Psychology)
Transplants
Immunosuppressive Agents
Insulin

Figure

  • Figure 1 Pancreas transplants worldwide.

  • Figure 2 Islet isolation from cadaveric donor.


Reference

1. Sutherland DE, Gruessner RWG, Dunn DL, Matas AJ, Humar A, Kandaswamy R, Mauer SM, Kennedy WR, Goetz FC, Robertson RP, Gruessner AC, Najarian JS. Lessons learned from more than 1000 pancreas transplants at a single institution. Ann Surg. 2001. 233:463–501.
Article
2. Krolewski AS, Warram JH, Freire MB. Epidemiology of late diabetic complications. A basis for the development and evaluation of preventive programs. Endocrinol Metab Clin North Am. 1996. 25:217–242.
3. The Diabetes Control and Complications Trial Research Group. 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. 329:977–986.
4. Han DJ, Jang HJ, Kim IK, Park KC, Min BC. Simultaneous pancreas and renal transplantation in TYPE I DM. J Korean Surg Soc. 1994. 46:273.
5. Han DJ, Kim TH, Kim SC. Pancreas transplantation in Asan Medical Center, Korea. Transplant Proc. 2001. 33:3499.
Article
6. Gruessner RW. Immunosuppression after pancreas transplantation. Transplant Proc. 2005. 37:1663–1666.
Article
7. Sutherland DER, Moudrymunns KC. International pancreas transplantation registry analysis. Transpl Proc. 1990. 22:571–574.
8. Gruessner RWG, Sutherland DER, Najarian JS, Dunn DL, Gruessner AC. Solitary pancreas transplantation for nonuremic patients with labile insulin-dependent diabetes mellitus. Transplantation. 1997. 64:1572–1577.
Article
9. Sutherland DER, Kendall DM, Moundry KC. Pancreas transplantation in non uremic, type I diabetic recipients. Surgery. 1988. 104:453–464.
10. Gruessner RWG, Kandaswamy R, Denny R. Laparoscopic simultaneous nephrectomy and distal pancreatectomy from a live donor. J Am Coll Surg. 2001. 193:333–337.
Article
11. Horgan S, Galvani C, Gorodner V, Bareato U, Umberto PF, Oberholzer J, Benedetti E. Robotic dital pancreatectomy and nephrectomy for living donor pancreas-kidney transplantation. Transplantation. 2007. 84:934–936.
Article
12. Dubernard JM, Traeger J, Neyra P, Touraine JL, Tranchant D, Blanc-Brunat N. A new method of preparation of segmental pancreatic grafts for transplantation: Trials in dog and in human. Surgery. 1978. 84:633–639.
13. Sollinger HW, Pirsch JD, D'Alessandro AM. Advantages of bladder drainage in pancreas transplantation: A personal view. Clin Transpl. 1990. 4:32–36.
14. Han DJ, Kim IK, Park KC. Refractory graft duodenitis and bleeding following enteric diversion of transplanted pancreas with bladder drainage. Transpl Proc. 1994. 26:2292–2293.
15. Carpentier A, Patterson BW, Uffelman KD, Giacca A, Vranic M, Cattral MS, Lewis GF. The effect of systemic versus portal insulin delivery in pancreas transplantation on insulin action and VLDL metabolism. Diabetes. 2001. 50:1402–1413.
Article
16. Bagdade JD, Ritter MC, Kitachi AE, Huss E, Thistlethwaite R, Gabfr O, Lambeth H. Differing effects of pancreas-kidney transplantation with systemic versus portal-venous drainage on cholesteryl ester transfer in IDDM subjects. Diabetes Care. 1996. 19:1108–1112.
Article
17. Sutherland DE, Goetz FC, Najarian JS. Living-related donor segmental pancreatectomy for transplantation. Transplant Proc. 1980. 12:4 S 2. 19–25.
18. Gruessner RW, Burke GW, Stratta R, Sollinger H, Benedetti E, Marsh C, Stock P, Boudreaux JP, Martin M, Drangstveit MB, Sutherland DER, Gruessner A. A multicenter analysis of the first experience with FK506 for induction and rescue therapy after pancreas transplantation. Transplantation. 1996. 61:261–273.
Article
19. Stratta RJ. The FK/MMF Multi-Center Study Group. Simultaneous use if tacrolimus and mycophenolate mofetil in combined pancreas-kidney transplant recipients: a multicenter report. Transplant Proc. 1997. 29:654–655.
Article
20. Gruessner RWG, Sutherland DER, Parr E, Humar A, Gruessner AC. A prospective, randomized, open-label study of steroid withdrawal in pancreas transplantation-A preliminary report with 6-month follow-up. Transplant Proc. 2001. 33:1663–1644.
Article
21. Kaufman DB. A Prospective Study of Rapid Corticosteroid Elimination in Simultaneous Pancreas-Kidney Transplantation. Comparison of two maintenance immunosuppression protocols: Tacrolimus/mycophenolate mofetil versus tacrolimus/sirolimus. Transplantation. 2002. 73:169–177.
Article
22. Bilous RW, Mauer SM, Sutherland DER. The effects of pancreas transplantation on the glomerular structure of renal allografts in patients with insulin dependent diabetes. N Engl J Med. 1989. 321:80–85.
Article
23. Tyden G, Brattstrom C, Bolinder J, Bohman S, Groth C, Brekke I, Holdaas H, Flatmark A. Long-term metabolic control in recipients of segmental-pancreas grafts with pancreaticoenterostomy or duct obstruction. Diabetes. 1989. 38:94–96.
Article
24. Abouna GM, Sutherland DER, Florack G, Heil J, Najarian JS. Preservation of human pancreatic allografts in cold storage for six to 24 hours. Transpl Proc. 1987. 19:2307–2309.
25. Pavlakis M, Khwaja K. Pancreas and islet cell transplantation in diabetes. Curr Opin Endocrinol Diabetes Obes. 2007. 14:146–150.
Article
26. Hering BJ, Ricordi C. Islet transplantation for patients with type I diabetes. Graft. 1999. 2:12–27.
27. Shapiro AM, Lakey JR, Ryan EA, Korbutt GS, Toth E, Warnock GL, Kneteman NM, Rajotte RV. Islet transplantation in seven patients with type I diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. N Engl J Med. 2000. 343:230–238.
Article
28. Shapiro J, Ricordi C, Hering BJ, Auchincloss H, Lindblad R, Robertson P, Secchi A, Brendel MD, Berney T, Brennan DC, Cagliero E, Alejandro R, Ryan E, dimercurio B, Morel P, Polonsky KS, Reems JA, Bretzel R, Bertuzzi F, Froud T, Kandaswamy R, Sutherland DER, Eisenbarth G, Segal M, Preiksaitis J, Korbutt GS, Barton FB, Viviano L, Seyfert-Margolis V, Bluestone J, Lakey JRT. International trial of the edmonton protocol for islet transplantation. N Engl J Med. 2006. 355:1318–1330.
Article
29. Bretzel R, Jahr H, Eckhard M, Martin I, Winter D, Brendel MD. Islet cell transplantation today. Langenbecks Arch Surg. 2007. 392:239–253.
Article
30. Shapiro J. Islet transplantation. 2008. Presented at AST.
Full Text Links
  • JKMA
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr