In a nutshell
This study examined the outcomes of a pancreas-kidney transplant and an islet-kidney transplant in type 1 diabetics.
Some background
In patients with type 1 diabetes (T1D) the immune system attacks the pancreas. The pancreas then fails to produce insulin. Patients therefore require insulin replacement therapy. A pancreas transplant can allow patients to produce insulin without needing daily injections. An islet transplant involves transplanting only the part of the pancreas which secretes insulin (the islet cells). In comparison to a pancreas transplant, an islet transplant is a minor surgical procedure and is less expensive.
T1D patients may also develop kidney disease due to chronic high blood glucose levels damaging the kidney. In T1D patients that receive dialysis, a kidney transplant may be required. Due to the complications of transplantation, T1D patients may only receive a pancreas or islet transplant if they are also receiving a kidney transplant. In this case, patients may receive a pancreas or islet from the donor donating the kidney. It is not known whether a pancreas-kidney transplant is more or less effective in the long-term compared to an islet-kidney transplant.
Methods & findings
This study aimed to compare the long-term outcomes between a pancreas-kidney transplant and an islet-kidney transplant.
This study involved 132 T1D patients divided into 2 groups. 94 patients received a pancreas-kidney transplant. 38 patients received an islet-kidney transplant. Patients were followed-up over a 13 year period.
The HbA1c (average blood glucose levels over 3 months) decreased from 7.8 to 5.9 mmol/L in patients who received the pancreas-kidney transplant. The HbA1c decreased from 8 to 6.5 mmol/L in patients who received an islet-kidney transplant.
The rate of hypoglycemia (dangerously low blood glucose levels) decreased by more than 90%. 73.6% of participants who received a pancreas-kidney transplant did not require insulin after 5 years. 9.3% of participants who received an islet-kidney transplant did not require insulin after 5 years.
Further surgery due to complications was needed in 41.5% of participants who received a pancreas-kidney transplant. 10.5% of participants receiving an islet-kidney transplant needed further surgery. Complications included bleeding and infections.
The bottom line
This study concluded that both a pancreas-kidney and islet-kidney transplant can improve control of blood glucose levels in the long-term. Insulin-independence is more common in patients receiving a pancreas-kidney compared to an islet-kidney transplant.
The fine print
The number of participants who experienced serious infections was not recorded.
What’s next?
Consult your physician regarding the risks and benefits of obtaining a pancreas-kidney transplant and whether it is suitable for you.
Published By :
Diabetes Care
Date :
Feb 09, 2015
