Pancreas Versus Islets After a Successful Kidney Transplant

Abstract

The optimal endocrine transplant that should follow a successful kidney transplant in patients with type 1 diabetes is currently open to debate. Ideally, a combined kidney and pancreas transplant is carried out simultaneously from an optimal donor as there is clear immunological benefit. However, when a living donor kidney transplant occurs initially, either a pancreas after kidney or islet after kidney transplant may be considered. A pancreas after kidney transplant carries more surgical risk but provides more robust endocrine reserve compared to the alternative option of islet after kidney transplantation. Furthermore, islet transplantation is not universally available, requires specialized manufacturing facilities, and the costs associated with islet manufacture may not be reimbursable by healthcare. From a patient's perspective, however, islet after kidney transplantation is a highly attractive option to avoid further surgical risk and recovery. This paper discusses the merits and demerits of these alternative transplant options, and debates both competitive aspects and complementarity. We discuss current outcomes and ongoing clinical trials.

Whole-Organ Pancreas and Islets Transplantations in UK: An Overview and Future Directions

“…More recently, technical failure rates have dropped to 5%, and pancreas allograft survival in PAK has improved, with, respectively, 85% and 60% of patients being insulin-free at one-0year and five years [34]. A PAK exposes the patient to more surgical risk but generally provides higher endocrine reserve compared to the alternative option of IAK transplantation, which is usually proposed for patients considered not fit enough for major surgery [35]. An unresolved aspect of PAK and IAK is optimal timing for the transplant after a successful kidney transplant.…”

“…Xenogeneic islets isolated from pigs is another area of research. Trials of porcine islet xenografts transplanted into primate models have shown a potential to achieve insulin independence and prolonged islet-graft function (>600 days) [34,35]. The disadvantage is that it seems to cause a greater immunological hurdle compared with islet allotransplantation [26,83].…”