Long-term Metabolic Outcomes of Functioning Pancreas Transplants in Type 2 Diabetic Recipients

Shin, Sung; Jung, Chang Hee; Choi, Ji Yoon; Kwon, Hyun Wook; Jung, Joohee; Kim, Young Hoon; Han, Duck Jong

doi:10.1097/tp.0000000000001269

Cited by 29 publications

(37 citation statements)

References 25 publications

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“…Peri-and post-SPK transplant complication rates as well as pancreas associated complication rates described here were similar for both groups (T1DM and T2DM) as described earlier [9][10][11][12][13][14]34]. The higher delayed graft function (DGF) rate and serum creatinine level at discharge in our T2DM control group which only received a KTA may be attributed to an inferior donor organ quality as reflected in a higher donor age and BMI [35].…”

Section: Discussionsupporting

confidence: 82%

“…This is why ET introduced special allocation guidelines for patients with T2DM requesting for a SPK [6]. Few studies from European and international transplant centers report, that under these strict selection criteria medium-and long-term outcomes for T1DM and T2DM patients receiving pancreas transplants are comparable good [9][10][11][12][13][14]. Still, the popularity of pancreas transplantation for T2DM remains low.…”

Section: (Continued From Previous Page)mentioning

confidence: 99%

“…Recently few studies were performed investigating the metabolic outcomes of pancreas transplantation in T1DM, however limited data are available for T2DM patients [10,[18][19][20]. First reports nonetheless indicate that pancreas transplantation is capable of sustaining favorable endocrine functions and that there is no significant difference in insulin resistance or b-cell function between T1DM and T2DM in the long term [10].…”

Section: (Continued From Previous Page)mentioning

confidence: 99%

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Short and long-term metabolic outcomes in patients with type 1 and type 2 diabetes receiving a simultaneous pancreas kidney allograft

et al. 2020

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Background:In contrast to insulin-dependent type 1 diabetes mellitus (T1DM), the indication for Simultaneous pancreas-kidney transplantation (SPK) in patients with type 2 diabetes mellitus (T2DM) is still ambiguous and wisely Eurotransplant (ET) only granted transplant-permission in a selected group of patients. However, with regard to improvement of metabolic conditions SPK might still be a considerable treatment option for lean insulin dependent type 2 diabetics suffering from renal disease.Methods: Medical data (2001-2013) from all consecutive T1DM and T2DM patients who received a SPK or kidney transplant alone (KTA) at the University Hospital of Leipzig were analyzed. Donor, recipients and long-term endocrine, metabolic and graft outcomes were investigated for T1DM and T2DM-SPK recipients (transplanted upon a special request allocation by ET) and T2DM patients who received a KTA during the same period.Results: Eighty nine T1DM and 12 T2DM patients received a SPK and 26 T2DM patients received a KTA. Patient survival at 1 and 5 years was 89.9 and 88.8% for the T1DM group, 91.7 and 83.3% for the T2DM group, and 92.3 and 69.2% for the T2DM KTA group, respectively (p < 0.01). Actuarial pancreas graft survival for SPK recipients at 1 and 5 years was 83.1 and 78.7% for the T1DM group and 91.7 and 83.3% for the T2DM group, respectively (p = 0.71). Kidney allograft survival at 5 years was 79.8% for T1DM, 83.3% for T2DM, and 65.4% for T2DM KTA (p < 0.01). Delayed graft function (DGF) rate was significantly higher in type 2 diabetics received a KTA. Surgical, immunological and infectious complications showed similar results for T1DM and T2DM recipients after SPK transplant and KTA, respectively. With regard to the lipid profile, the mean high-density lipoprotein (HDL)cholesterol levels were significantly higher in T1DM recipients compared to T2DM patients before transplantation (p = 0.02) and remained significantly during follow up period.(Continued on next page)

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Section: Discussionsupporting

confidence: 82%

Section: (Continued From Previous Page)mentioning

confidence: 99%

Section: (Continued From Previous Page)mentioning

confidence: 99%

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Short and long-term metabolic outcomes in patients with type 1 and type 2 diabetes receiving a simultaneous pancreas kidney allograft

et al. 2020

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“…Similar to Stratta et al[62], this study indicates that “C-peptide positive” (T2DM phenotype) patients can have favorable outcomes post SPK transplant[64]. A more recent by Shin et al[65] compared 5-year outcomes among 151 T1DM and 42 T2DM pancreas transplant recipients. There was no difference in hemoglobin A1c levels, fasting insulin levels, homeostasis model assessment of insulin resistance or the insulinogenic index between the groups.…”

Section: Pancreas Transplant Candidatessupporting

confidence: 70%

“…There was no difference in hemoglobin A1c levels, fasting insulin levels, homeostasis model assessment of insulin resistance or the insulinogenic index between the groups. Notably, insulin resistance decreased between both groups, even though T2DM recipients kept significantly higher C-peptide levels[65].…”

Section: Pancreas Transplant Candidatesmentioning

confidence: 99%

Solid pancreas transplant: Pushing forward

Giorgakis

Mathur

Chakkera

et al. 2018

WJT

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Pancreas transplant has evolved significantly in recent years. It has now become a viable treatment option on type 1 diabetic patients with poorly controlled diabetes on conventional treatment, insulin intolerance, hypoglycaemia unawareness, brittle diabetes and/ or end-stage kidney disease. The purpose of this review is to provide an overview of pancreas transplant historical origins and current barriers to broader utilization of pancreata for transplant, with a focus on areas for future improvement to better pancreas transplant care. Donor pancreata remain underutilized; pancreatic allograft discard rates remain close to 30% in the United States. Donations after cardiac death (DCD) pancreata are seldom procured. Study groups from Europe and the United Kingdom showed that procurement professionalization and standardization of technique, as well as development of independent regional procurement teams might increase organ procurement efficiency, decrease discards and increase pancreatic allograft utilization. Pancreas transplant programs should consider exploring pancreas procurement opportunities on DCD and obese donors. Selected type 2 diabetics should be considered for pancreas transplant. Longer follow-up studies need to be performed in order to ascertain the long-term cardiovascular and quality of life benefits following pancreas transplant; the outcomes of which might eventually spearhead advocacy towards broader application of pancreas transplant among diabetics.

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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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Long-term Metabolic Outcomes of Functioning Pancreas Transplants in Type 2 Diabetic Recipients

Abstract: There was no significant difference in the insulin resistance or β-cell function after pancreas transplantation between T1DM and T2DM patients. We demonstrated that pancreas transplantation is capable of sustaining favorable endocrine functions for more than 5 years in T2DM recipients.

Cited by 29 publications

References 25 publications

Short and long-term metabolic outcomes in patients with type 1 and type 2 diabetes receiving a simultaneous pancreas kidney allograft

Short and long-term metabolic outcomes in patients with type 1 and type 2 diabetes receiving a simultaneous pancreas kidney allograft

Solid pancreas transplant: Pushing forward

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

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