Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Diabetes Reports
Published in: Current Diabetes Reports 11/2014

01-11-2014 | Transplantation (A Pileggi, Section Editor)

Type 2 Diabetes: Is Pancreas Transplantation an Option?

Authors: Gaetano Ciancio, George W. Burke

Published in: Current Diabetes Reports | Issue 11/2014

Login to get access

Abstract

Transplantation of the whole vascularized pancreas can provide insulin secretion in patients with insulin-dependent, type 1 diabetes mellitus (T1D). It restores euglycemia in most patients, with the potential to impact the chronic diabetic complications and quality of life. Pancreas transplantation (PT) is presently controversial for type 2 diabetes mellitus (T2D). For those patients with severe glycemic dysregulation, T2D can be associated with the same life-threatening sequelae as T1D such as severe hypoglycemia and kidney failure that could be corrected by pancreas (and kidney) transplantation. Thus, clinical indications and patient selection criteria are very important. This chapter will review the current status of PT for T2D and discuss the options and evolution of transplant perspectives.
Literature
1.
Leichtman AB, Cohen D, Keith D, et al. Kidney and pancreas transplantation in the United States, 1997–2006: the HRSA Breakthrough Collaboratives and the 58 DSA Challenge. Am J Transplant. 2008;8(4 Pt 2):946–57.PubMedCrossRef
2.
Burke GW, Ciancio G, Sollinger HW. Advances in pancreas transplantation. Transplantation. 2004;77(9 Suppl):S62–7.PubMedCrossRef
3.
Ciancio G, Burke GW, Miller J. Current treatment practices in immunosuppression. Expert Opin Pharmacother. 2000;1:1307–30.PubMedCrossRef
4.
Ciancio G, Mattiazzi A, Roth D, Kupin W, Miller J, Burke GW. The use of daclizumab as induction therapy in combination with tacrolimus and mycophenolate mofetil in recipients with previous transplants. Clin Transplant. 2003;17(5):428–32.PubMedCrossRef
5.
Burke GW, Ciancio G. Critical care issues in the renal and pancreatic allograft recipient. In: Civetta JM, Taylor RW, Kirby RR, editors. Critical care. 3rd ed. Philadelphia: J.B. Lippincott Company; 1997. p. 1311–5.
6.
7.
Stumvoll M, Goldstein BJ, Van Haeften TW. Type 2 diabetes: pathogenesis and treatment. Lancet. 2008;371(9631):2153–6.PubMedCrossRef
8.
Ferchak CV, Meneghini LF. Obesity, bariatric surgery, and type 2 diabetes. Diabetes Metab Res Rev. 2004;6:438–45.CrossRef
9.
Sampaio MS, Kuo HT, Bunnapradist S. Outcomes of simultaneous pancreas-kidney transplantation in type 2 diabetic recipients. Clin J Am Soc Nephrol. 2011;6:1198–206.PubMedCentralPubMedCrossRef
10.
Wiseman AC, Gralla J. Simulatenous pancreas kidney transplant versus other kidney options in patients with type 2 diabetes. Clin J Am Soc Nephrol. 2012;7:656–64.PubMedCrossRef
11.
Gruessner AC. 2011 update on pancreas transplantation: comprehensive trend analysis of 25,000 cases followed up over the course of twenty-four years at the International Pancreas Transplant Registry (IPTR). Rev Diabet Stud. 2011;8:6–16.PubMedCentralPubMedCrossRef
12.
Scalea JR, Cooper M. Surgical strategies for type II diabetes. Transplant Rev. 2012;26:177–82.CrossRef
13.
American Diabetes Association Expert Committee. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003;26:S5–20.CrossRef
14.••
Ciancio G, Sageshima J, Chen L, et al. Advantage of rapamycin over mycophenolate mofetil when used with tacrolimus for simultaneous kidney transplant recipients: randomized, single-center trial at 10 years. Am J Transplant. 2012;2:3363–76. This paper illustrates long-term survival of pancreas transplantation in a randomized prospective trial. CrossRef
15.
Nath DS, Gruessner AC, Kandaswamy R, et al. Outcomes of pancreas transplants for patients with type 2 diabetes mellitus. Clin Transplant. 2005;19:792–7.PubMedCrossRef
16.•
Orlando G, Stratta RJ, Light J. Pancreas transplantation for type 2 diabetes mellitus. Curr Opin Organ Transplant. 2010;16:110–5. This paper provides evidence that some patients with T2D will benefit from pancreas transplantation. CrossRef
17.
Singh RP, Rogers J, Farney A, et al. Do pretransplant C-peptide levels influence outcomes in simultaneous kidney-pancreas transplantation? Transplant Proc. 2008;40:510–2.PubMedCrossRef
18.
Light JA, Barhyte DY. Simultaneous pancreas-kidney transplants in type I and type II diabetic patients with end-stage renal disease. Similar 10-year outcomes. Transplant Proc. 2005;37:1283–4.PubMedCrossRef
19.
Esmatjes E, Fernandez C, Rueda S, et al. The utility of the C-peptide in the phenotyping of patient candidates for pancreas transplantation. Clin Transplant. 2007;21:358–62.PubMedCrossRef
20.
Burke GW, Ciancio G, Olson L, Roth D, Miller J. Ten-year survival after simultaneous pancreas/kidney transplantation with bladder drainage and tacrolimus-based immunosuppression. Transplant Proc. 2001;33(1–2):1681–3.PubMedCrossRef
21.
22.
Nathan DM, Cleary PA, Backlund JY, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. NEJM. 2005;353:2643–53.PubMedCrossRef
23.
Friedman AL, Friedman EA. Pancreas transplantation for type 2 diabetes at U.S. transplant centers. Diabetes Care. 2002;25:1896.PubMedCrossRef
24.
Sasaki TM, Gray RS, Ratner RE, et al. Successful long-term kidney-pancreas transplants in diabetic patients with high C-peptide levels. Transplantation. 1998;65:1510–2.PubMedCrossRef
25.
Light JA, Sasaki TM, Currier CB, Barhyte DY. Successful long term kidney-pancreas transplants regardless of C-peptide status and race. Transplantation. 2001;71:152–4.PubMedCrossRef
26.
Nath DS, Gruessner AC, Kandaswamy R, Gruessner RW, Sutherland DER, Humar A. Outcomes of pancreas transplants for patients with type 2 diabetes mellitus. Clin Transplant. 2005;19:792–7.PubMedCrossRef
27.••
Margreiter C, Resch T, Oberhuber R, Aigner F, Maier H, Sucher R, et al. Combined pancreas-kidney transplantation for patients with end-stage nephropathy caused by type-2 diabetes mellitus. Transplantation. 2013;95:1030–6. This paper reports recent experience with pancreas transplantation in T2D patients. PubMedCrossRef
28.
Vendrame F, Pileggi A, Laughlin E, et al. Recurrence of type 1 diabetes after simultaneous pancreas-kidney transplantatiom, despite immunosuppression, is associated with autoantibodies and pathogenic autoreactive CD4 T-cells. Diabetes. 2010;59:947–57.PubMedCentralPubMedCrossRef
29.
Coppelli A, Giannarelli R, Vistoli F, et al. The beneficial effects of pancreas transplant alone on diabetic nephropathy. Diabetes Care. 2005;28(6):1366–70.PubMedCrossRef
30.
Fioretto P, Mauer SM, Bilous RW, Goetz FC, Sutherland DE, Steffes MW. Effects of pancreas transplantation on glomerular structure in insulin-dependent diabetic patients with their own kidneys. Lancet. 1993;342(8881):1193–6.PubMedCrossRef
31.
Fioretto P, Steffes MW, De Sutherland, Goetz FC, Mauer M. Reversal of lesions of diabetic nephropathy after pancreas transplantation. N Eng J Med. 1998;339(2):69–75.CrossRef
32.
Fioretto P, Sutherland DE, Najafian B, Mauer M. Remodeling of renal interstitial and tubular lesions in pancreas transplant recipients. Kidney Int. 2006;69(5):907–12.PubMedCrossRef
33.
Giannarelli R, Coppelli A, Sartini MS, et al. Pancreas transplant alone has beneficial effects on retinopathy in type 1 diabetic patients. Diabetologia. 2006;49(12):2977–82.PubMedCrossRef
34.
Pearce IA, Ilango B, Sells RA, Wong D. Stabilisation of diabetic retinopathy following simultaneous pancreas and kidney transplant. Br J Ophthalmol. 2000;84(7):736–40.PubMedCentralPubMedCrossRef
35.
Hathaway DK, Hartwig MS, Milstead J, Elmer D, Evans S, Gaber AO. Improvement in quality of life reported by diabetic recipients of kidney-only and pancreas-kidney allografts. Transplant Proc. 1994;26(2):512–4.PubMed
36.
Navarro X, Sutherland DE, Kennedy WR. Long-term effects of pancreatic transplantation on diabetic neuropathy. Ann Neurol. 1997;42(5):727–36.PubMedCrossRef
37.
Guerra G, Ilahe A, Ciancio G. Diabetes and kidney transplantation: past, present, and future. Curr Diab Rep. 2012;12(5):597–603.PubMedCrossRef
38.
Meier-Kriesche HU, Stegall MD. Should we be performing pancreas transplants? Am J Transplant. 2004;4(12):1935–6.PubMedCrossRef
39.
Dean PG, Kudva YC, Larson TS, Kremers WK, Stegall MD. Posttransplant diabetes mellitus after pancreas transplantation. Am J Transplant. 2008;8(1):175–82.PubMed
Metadata
Title
Type 2 Diabetes: Is Pancreas Transplantation an Option?
Authors
Gaetano Ciancio
George W. Burke
Publication date
01-11-2014
Publisher
Springer US
Published in
Current Diabetes Reports / Issue 11/2014
Print ISSN: 1534-4827
Electronic ISSN: 1539-0829
DOI
https://doi.org/10.1007/s11892-014-0542-9

Other articles of this Issue 11/2014

Current Diabetes Reports 11/2014 Go to the issue

Genetics (AP Morris, Section Editor)

Fine Mapping of Type 2 Diabetes Susceptibility Loci

Genetics (AP Morris, Section Editor)

Overlap of Genetic Susceptibility to Type 1 Diabetes, Type 2 Diabetes, and Latent Autoimmune Diabetes in Adults

Psychosocial Aspects (KK Hood, Section Editor)

Predictors of Self-Management in Pediatric Type 1 Diabetes: Individual, Family, Systemic, and Technologic Influences

Psychosocial Aspects (KK Hood, Section Editor)

Good Cop, Bad Cop: Quality of Parental Involvement in Type 1 Diabetes Management in Youth

Pathogenesis of Type 1 Diabetes (A Pugliese, Section Editor)

Role of B Lymphocytes in the Pathogenesis of Type 1 Diabetes

Genetics (AP Morris, Section Editor)

Insights into the Genetic Susceptibility to Type 2 Diabetes from Genome-Wide Association Studies of Glycaemic Traits
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits