Abstract
Transplantation of whole pancreas or of purified pancreatic islets can restore insulin secretion in patients with insulin-dependent, type 1 diabetes (T1D). Both procedures reverse diabetes in most patients, improving chronic complications and quality of life, but require chronic, systemic immunosuppression. Given the side effects and health risks associated with immunosuppression, exogenous insulin therapy remains the mainstay of treatment for most patients with T1D, unless patients cannot adequately control their metabolism with exogenous insulin or develop life-threatening complications (such as severe hypoglycemia and kidney failure) that can be corrected by transplantation. While pancreas transplantation is presently associated with longer graft survival and function than islet transplantation, it requires invasive surgery compared to the less invasive islet infusion procedure and has a higher risk of perioperative mortality and morbidity. Thus, clinical indications and patient selection criteria for the two procedures are different. Islet transplants are mostly performed in patients with brittle diabetes and severe hypoglycemia. Patients with end stage renal disease are candidates for simultaneous-kidney pancreas transplantation, which accounts for the majority of pancreas transplants. This chapter will review the current status of both islet and pancreas transplantation and discuss major challenges and future directions.
