Impact of Type 1 and Type 2 Diabetes Mellitus on Pancreas Transplant Outcomes

Rohan, Vinayak; Taber, David J.; Palanisamy, Arun P.; McGillicuddy, John W.; Chavin, Kenneth D.; Baliga, Prabhakar K.; Bratton, C. B.

doi:10.6002/ect.2017.0296

Cited by 10 publications

(17 citation statements)

References 21 publications

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“…Previous International Pancreas Transplant Registry analyses have also shown excellent outcomes in both T2DM and T1DM patients who underwent SPK transplantation (1,18,19). Moreover, a plethora of reports in the literature, including case series, single-center reviews, and multiple analyses, have demonstrated noninferior and favorable outcomes of pancreas transplantation in T2DM recipients compared with T1DM recipients (1)(2)(3)(4)6,(8)(9)(10)(11)(12)(13)(14)(15)18,(20)(21)(22)(23)(24). Therefore, based on our results and evidences in the literature, pancreas transplantation would be justified in selected T2DM patients, especially with ESRD, who have already been under insulin control but without significant insulin resistance.…”

Section: Discussionmentioning

confidence: 98%

“…Some centers require limited insulin resistance (insulin requirement <1 U/kg/day), insulin requirement >5 years, BMI <32 kg/m 2 , fasting C-peptide level <10 ng/mL, presence of glucose hyperlability with complicated diabetes control, age <60 years, and minimal cardiovascular comorbidities (1,4,16,17), while other centers use less strict criteria (1). Most centers, including our center, consider pancreas transplantation (SPK or PAK transplantation) mainly for T2DM with ESRD (1,4,18,19). PTA in T2DM remains to be reserved for those with severe metabolic disturbances and incapacitating clinical and emotional problems with exogenous insulin therapy, which would be generally rare among the T2DM patients and should be considered in case-by-case basis (3).…”

Section: Discussionmentioning

confidence: 99%

“…Although many criteria, including a family history of diabetes, age of DM onset, body mass index (BMI), human leukocyte antigen (HLA) association, and detectable connecting peptide (C-peptide), have been proposed to differentiate these two types of DM, several patients are still found to categorically overlap. Moreover, older age, associated cardiovascular risks, and advanced secondary diabetic complications might also be suggested as the listed deterrents (3)(4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

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A comparative study of pancreas transplantation between type 1 and 2 diabetes mellitus

Shyr¹,

Shyr²,

Chen³

et al. 2021

Hepatobiliary Surg Nutr

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Background: Pancreas transplantation remains the best long-term treatment option to achieve physiological euglycemia and insulin independence in patients with labile diabetes mellitus (DM). It is widely accepted as an optimal procedure for type 1 DM (T1DM), but its application in type 2 DM (T2DM) is not unanimously acknowledged.Methods: In total, 146 diabetes patients undergoing pancreas transplantation were included in this study.Clinical data and outcomes were compared between the T1DM and T2DM groups.Results: Majority (93%) of the pancreas transplantations in T2DM were for uremic recipients.Complications occurred in 106 (73%) patients, including 70 (48%) with early complications before discharge and 79 (54%) with late complications during follow-up period. Overall, rejection of pancreas graft occurred in 37 (25%) patients. Total rejection rate in T2DM recipients was significantly lower than that in T1DM.The short-and long-term outcomes for endocrine function in terms of fasting blood sugar and hemoglobin A1c levels and graft survival rates are comparable between the T2DM and T1DM groups.Conclusions: T2DM is not inferior to T1DM after pancreas transplantation in terms of surgical risks, immunological and endocrine outcomes, and graft survival rates. Therefore, pancreas transplantation could be an effective option to treat selected uremic T2DM patients without significant insulin resistance.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A comparative study of pancreas transplantation between type 1 and 2 diabetes mellitus

Shyr¹,

Shyr²,

Chen³

et al. 2021

Hepatobiliary Surg Nutr

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show abstract

“…At present, pancreas transplantation from BDDs is indicated only for patients with type 1 diabetes. However, there are a handful of successful reports from various countries concerning the outcomes of pancreas transplantation for patients with type 2 diabetes 26‐30 . Although the expansion of indications for pancreas transplantation for patients with type 2 diabetes will require even more donations from BDD, the increase in the number of pancreas transplantations following the revision of the law is promising, supporting the advent of selective therapy with pancreas transplantation or islet transplantation for patients with type 2 diabetes as well as those with type 1 diabetes in the near future.…”

Section: Discussionmentioning

confidence: 99%

Impact of the revision of the law on pancreatic transplants in Japan—An analysis of the Japanese Pancreas Transplants Registry

Ito

Kenmochi

Aida

et al. 2021

J Hepato Biliary Pancreat

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Background In Japan, it has been about 10 years since the revision of the law on donating brain‐dead organs. The present study compared the outcomes of pancreatic transplant before and after the revision of the law. Methods The 437 patients who had received pancreas transplantation were divided into two groups according to the time when pancreas transplantation was performed between era 1 (before the revision) and 2 (after the revision), and compared in the patient and pancreas graft survival. Results While the annual number of brain‐dead donors was <10 in era 1, and this number significantly increased in era 2 to >50. This resulted in an increased number of pancreas transplantations: >30 cases per year. The comparison data after a propensity score‐matched analysis revealed that the death‐censored pancreatic graft survival at 1, 3, and 5 years after pancreas transplantation in era 2 was 94.9%, 92.0%, and 92.0%, which, while lacking significance, tended to be better than the values of 90.5%, 83.1%, and 78.2%, respectively, in era 1. Conclusions The revision of the law on donating brain‐dead organs increased the number of pancreas transplantations. Technical improvements in surgery due to increased experience with performing pancreas transplants may help improve pancreatic graft survival.

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“…27 Surgical and infectious complications and readmissions are similar to those of T1DM recipients, even though BMI is typically higher in T2DM recipients. [28][29][30][31] The glycemic control up to 2 years after pancreas transplantation is comparable in recipients with T2DM to that in recipients with T1DM, but more post-transplant weight gain is experienced in T2DM recipients. 30…”

Section: Diabetes Typementioning

confidence: 99%

Transplant Options for Patients With Diabetes and Advanced Kidney Disease: A Review

Kukla

Ventura‐Aguiar

Cooper

et al. 2021

American Journal of Kidney Diseases

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Optimal glycemic control in kidney transplant recipients with diabetes is associated with improved morbidity and better patient and allograft survival. Transplant options for patients with diabetes requiring insulin therapy and chronic kidney disease who are suitable candidates for kidney transplantation should include consideration of β-cell replacement therapy: pancreas or islet transplantation. International variation related to national regulatory policies exists in offering one or both options to suitable candidates and is further affected by pancreas/islet allocation policies and transplant waiting list dynamics. The selection of appropriate candidates depends on patient age, coexistent morbidities, the timing of referral to the transplant center (predialysis versus on dialysis) and availability of living kidney donors. Therefore, early referral (estimated glomerular filtration rate < 30 mL/min/ 1.73 m 2 ) is of the utmost importance to ensure adequate time for informed decision making and thorough pretransplant evaluation. Obesity, cardiovascular disease, peripheral vascular disease, smoking, and frailty are some of the conditions that need to be addressed before acceptance on the transplant list, and ideally before dialysis becoming imminent. This review offers insights into selection of pancreas/islet transplant candidates by transplant centers and an update on posttransplant outcomes, which may have practice implications for referring nephrologists.Complete author and article information provided before references.

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Impact of Type 1 and Type 2 Diabetes Mellitus on Pancreas Transplant Outcomes

Cited by 10 publications

References 21 publications

A comparative study of pancreas transplantation between type 1 and 2 diabetes mellitus

A comparative study of pancreas transplantation between type 1 and 2 diabetes mellitus

Impact of the revision of the law on pancreatic transplants in Japan—An analysis of the Japanese Pancreas Transplants Registry

Transplant Options for Patients With Diabetes and Advanced Kidney Disease: A Review

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