Expanding access to pancreas transplantation for type 2 diabetes mellitus.

Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 9717388 Publication Model: Print Cited Medium: Internet ISSN: 1531-7013 (Electronic) Linking ISSN: 10872418 NLM ISO Abbreviation: Curr Opin Organ Transplant Subsets: MEDLINE

Publication: <2003->: Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: Philadelphia, PA : Rapid Science Publishers,

Diabetes Mellitus, Type 1*/surgery ; Diabetes Mellitus, Type 2*/diagnosis ; Diabetes Mellitus, Type 2*/surgery ; Pancreas Transplantation*/adverse effects; Graft Survival ; Humans ; Prospective Studies ; Retrospective Studies ; United States

Purpose of Review: The vast majority of cases of diabetes mellitus (DM) in the United States are classified as type 2 DM (T2DM). Restrictive listing criteria and uncertainty regarding outcomes have historically limited access to pancreas transplantation for individuals with T2DM, although it has been used with success in patients with type 1 DM (T1DM). This review summarizes several recent studies that have sought to clarify the indications, appropriate patient selection, and outcomes of pancreas transplantation in the setting of T2DM.
Recent Findings: Pancreas transplants have increased over the last few years, largely due to an increase in listings for simultaneous pancreas-kidney transplant (SPK) in patients with T2DM. Retrospective data demonstrate similar patient and allograft survival in patients with T1DM and T2DM undergoing SPK, and improved outcomes in patients with T2DM after SPK compared to those receiving a kidney transplant alone, although these studies are often confounded by selection biases. Patient selection for pancreas transplant has traditionally focused on body mass index, pretransplant insulin requirements, and fasting C-peptide, and the categorization of patients to T1DM or T2DM. Emerging data suggests this practice is inadvertently and unnecessarily restrictive.
Summary: There is a growing body of evidence to support increasing consideration of pancreas transplantation in patients with T2DM, with support for equivalent patient and graft survival and glycemic control. Future prospective studies are indicated to better evaluate the role of preoperative patient factors in selection for pancreas transplantation and to explore long-term outcomes in patients with T2DM.
(Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

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Date Created: 20210621 Date Completed: 20211015 Latest Revision: 20230917

20231215

10.1097/MOT.0000000000000901

34148982