Abstract
The availability of exogenous insulin therapy was a life-preserving advance for patients suffering from insulin-dependent diabetes mellitus (IDDM). However, it has uncovered the devastating long-term complications associated with micro- and macroangiopathy, which may lead to end-stage renal failure, lower limb amputation, or blindness [1]. Tight metabolic control, as provided by intensive insulin therapy, has been shown by the Diabetes Control and Complications Trial (DCCT) to significantly delay the occurrence of such complications [2], and to represent a fruitful long-term financial investment in terms of health care costs [3]. However, intensive therapy does not maintain constantly normal blood glucose levels, is a cumbersome modality, and is accompanied by an increased frequency of severe hypoglycemic episodes [4]. Islet replacement appears as a better way to achieve glucose control than exogenous insulin, since islets function for an entire lifetime, produce their own insulin, release it in a perfectly timed fashion and keep blood sugar levels in the normal range thanks to a built-in “glucose sensor” [5]. Currently, whole organ pancreas transplantation is an islet-replacing procedure able to provide sustained euglycemia and insulin-independence in a vast majority of recipients, with graft survival rates as high as 78% at 5 years [6].