The current state of pancreas transplantation

This review analyzed current research regarding pancreas transplantation for diabetic patients.

The hormone insulin is produced by the pancreas and is responsible for regulating blood sugar levels. In type 1 diabetes mellitus (T1DM), the pancreas does not produce insulin effectively. In type 2 diabetes mellitus (T2DM), the cells of the body become unresponsive to insulin, which eventually leads to the exhaustion of the insulin producing cells of the pancreas (called islet cells). Patients with T1DM, and some patients with T2DM, may benefit from a pancreas transplantation, which replaces the poorly functioning pancreas with a healthy donor pancreas. Pancreas transplantation is currently the only treatment for diabetic patients that can permanently correct blood sugar regulation without the need of insulin injections. Furthermore, it may permanently prevent complications of DM, such as kidney failure. However, the use of pancreas transplantations is usually limited to severely ill patients. Currently, only diabetic patients with kidney failure or those who experience frequent adverse events (such as dangerously low or high blood sugar levels or ketoacidosis) are eligible to receive a donor pancreas.

Pancreatic islet cell transplantation refers to the transplantation of insulin producing cells without receiving a complete donor organ. Because islet cells can be grown in a laboratory and require a less invasive surgery than whole pancreas transplantation, this avenue of therapy is a promising prospect. Currently, pancreatic islet cell transplantation is under research and only performed in clinical trials.

The authors of this review analyzed all research regarding pancreas transplantations for diabetic patients published up to March 2013. Three major categories of patients who received a donor pancreas were identified: Patients who received a combined pancreas and kidney transplantation to treat diabetes with kidney failure (84% of transplantations performed). Diabetic patients who received a donor pancreas after receiving a kidney transplantation intended to treat kidney failure (9% of transplantations performed). And patients with poorly controlled diabetes without kidney failure (7% of transplantations performed).

Overall, survival rates for all patients receiving a donor pancreas were good. 96% of patients survived more than one year after the transplant, and 80% of patients survived at least 5 years after the transplant. Transplanted patients showed improved survival when compared to patients still waiting for a donor pancreas. Survival of patients with kidney failure was improved in patients receiving a combined pancreas and kidney transplantation compared to patients receiving a donor kidney alone. Transplanted patients, in general, showed a reversal of diabetic complications. Improvements in kidney, eye and heart function, as well as improved control over blood sugar levels, were observed in the majority of patients. Approximately 85% of transplanted patients were insulin independent 1 year after transplantation (did not require any insulin injections), and 60% were insulin independent 5 years after transplantation. Most patients also reported a significant improvement to their quality of life.

Pancreatic islet cell transplantation, however, does not seem to provide the same long-term benefits as whole pancreas transplantation. 3 years after islet cell transplantation only 44% of patients were insulin independent. More research is needed before this therapeutic technique becomes a viable treatment option for diabetic patients.

This review concluded that pancreas transplantation provides a significant improvement to survival and quality of life, and should be considered as treatment for diabetes in earlier stages of the disease.

Any transplantation incurs the risk of rejection (when the body's immune system attacks the transplanted organ). The risk of rejection was highest (36%) in transplantations of a pancreas alone, and lowest when a pancreas was transplanted after a kidney (14%).

Consult with your physician regarding pancreas and islet cell transplantations in the treatment of uncontrolled diabetes.