Pancreas and Islet Transplantation

Allogeneic whole pancreas and isolated islet transplantation are established procedures for patients with insulin-dependent diabetes complicated by excessive glycemic lability and/or severe hypoglycemia events, or by the requirement for immunosuppression for a kidney transplant for end-stage diabetic nephropathy. Most often performed in patients with type 1 diabetes, pancreas transplantation is increasingly offered to patients with insulin-dependent type 2 diabetes requiring kidney transplant. Islet transplantation offers a minimally invasive alternative used mainly for the treatment of type 1 diabetes. Both approaches have demonstrated long-term improvement in metabolic control and reduction in diabetes-related complications balanced against the risk for immunosuppressive drug therapy. Autologous islet transplantation may mitigate postsurgical diabetes in patients requiring total pancreatectomy for treatment of pancreatitis and offers improvement in metabolic control and quality of life. Future work in genetically engineered porcine islets and stem cell-derived islets offers hope for a one day inexhaustible supply of islets to treat diabetes.