ABSTRACT
For these reasons, it has become clear that the restoration of an adequate islet mass would provide the best glucose regulation and long-term health outcome for patients with T1DM. The first efforts directed at addressing this issue have involved whole pancreas transplantation. Currently, more than 25,000 pancreas transplants have been performed worldwide for end-stage renal disease (simultaneous kidney pancreas or pancreas after kidney transplantation), or occasionally for severe hypoglycemic unawareness (pancreas transplant alone). Recent improvements
in surgical techniques (portal venous and enteric exocrine drainage) and maintenance of immunosuppression have substantially improved the risk profile and enhanced long-term outcomes with this approach (9,10). However, only 50% of the patients who have undergone pancreasalone transplantation still maintain evidence of graft function (insulin independence) at five years, according to the International Pancreas Transplant Registry (11). Also, recent data from the United Network for Organ Sharing have shown that only 28% of the approximately 6000 deceased donor pancreata donated each year are transplanted because the organ must conform to strict donor criteria and requirements for a short cold ischemic time to be considered suitable for transplantation (11,12). Despite strong evidence that the procedure can prolong life, reverse established nephropathy, and improve the quality of life, pancreas transplantation is not felt to be suitable for diabetic patients that are early in the evolution of their disease. Compared with vascularized pancreas transplantation, β-cell replacement via transplantation of isolated pancreatic islets offers a simpler procedure that avoids the risks associated with major surgery (11).
