The best insulin delivery is a human pancreas

McCune, Kasi; Owen‐Simon, Nina L.; Dube, Geoffrey K.; Sandoval, P. Rodrigo; Ratner, Lloyd E.

doi:10.1111/ctr.14920

Cited by 8 publications

(6 citation statements)

References 16 publications

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“…While effective at minimizing patients' hyper and hypoglycemic episodes, 27 McCune et al state that pancreas transplantation provides superior glycemic control over CGM. 28 Utilizing exogenously produced insulin does not provide the same glycemic control compared to endogenously produced insulin, and a pancreas transplant does not require timely injections of insulin leading to an improved quality of life. 23,24 Aspects that can be improved upon for future research are to use other databases apart from the UNOS database and to expand the time frame to have a better understanding of the trends in patient outcomes from PAK transplants as well as to include follow-up time points beyond only 5 and 10 years posttransplant, such as a 20-year posttransplant time point.…”

Section: Discussionmentioning

confidence: 99%

“…While effective at minimizing patients' hyper and hypoglycemic episodes, 27 McCune et al. state that pancreas transplantation provides superior glycemic control over CGM 28 . Utilizing exogenously produced insulin does not provide the same glycemic control compared to endogenously produced insulin, and a pancreas transplant does not require timely injections of insulin leading to an improved quality of life 23,24 …”

Section: Discussionmentioning

confidence: 99%

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Pancreas after kidney transplantation, is it the time to overcome the stigma?

Moein,

Maloney,

Baio

et al. 2024

World j. surg.

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BackgroundPancreas transplantation is the most effective treatment to improve quality of life and overcome complications in patients with end‐stage renal disease and diabetes mellitus. One of the main approaches for concurrent renal disease and diabetes mellitus which has been underutilized during the past decade is a pancreas transplant after kidney transplantation. Our study aimed to quantify outcomes following pancreas after kidney transplants (PAKs) in the United States from 2001 to 2020 with an emphasis on graft and patient survival.Methods and MaterialsA retrospective registry analysis was performed by accessing the OPTN/UNOS database for PAKs that were performed in the United States from January 2001 to April 2020. The study population was divided into two subgroups: patients receiving a pancreas transplant between 2001 and 2010 and those receiving a pancreas transplant between 2011 and 2020.ResultsThe study examined a total number of 3706 PAK recipients; patients who received a PAK from January 2001 through December 2010 (n = 2892) and those who received a PAK from January 2011 to April 2020 (n = 814). The selection process of transplant recipients did not drastically change throughout the 2001–2010 and 2011–2020 periods. Length of stay at the hospital after the transplantation improved significantly in the 2011–2020 group relative to the 2001–2010 group (8.48 vs. 10.08 days, mean, p < 0.01). Additionally, more transplantation with 4–6 human leukocyte antigen mismatch occurred in the 2011–2020 group than in the 2001–2010 group (80.6% vs. 71.4%, p < 0.01). The pancreas preservation time of 13.35 h in the 2001–2010 group decreased significantly to 11.17 h in the 2011–2020 group (p < 0.001). The mean donor's amylase and lipase also decreased significantly in the 2011–2020 cohort. Significant graft survival improvement was observed in the 2011–2020 group compared to the 2001–2010 group after a long‐term follow‐up (p < 0.001). The mean Calculated Pancreas Donor Risk Index was 1.08 for the 2001–2010 group and 0.99 for the 2011–2020 group with a significant difference (p < 0.001).ConclusionThe beneficial results and improved outcomes observed in PAK patients demonstrate the effectiveness of the operation for individuals in need of a pancreas transplant. PAKs can prove to be a meaningful solution to overcome long waiting times, decrease the donor‐recipient imbalance, expand the donor pool, and overcome the current underutilization in order to improve the short‐ and long‐term quality of life in the groups of interest.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pancreas after kidney transplantation, is it the time to overcome the stigma?

Moein,

Maloney,

Baio

et al. 2024

World j. surg.

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“…They mentioned an average of 3.4% decrease in HbA1c after the transplantation compared to the pre‐evaluation HbA1C levels, which continued to be the same even after 1 year of follow up. Even in patients who were on continuous glucose monitoring and insulin pump, the reduction in the HbA1C level was significant, with an average of 3.1% decrease [29].…”

Section: Discussionmentioning

confidence: 99%

Pancreas Transplant Alone in the USA, Where Do We Stand?

et al. 2023

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Background Currently, over 63,000 pancreas transplant procedures have been performed worldwide, with only approximately 8% of all pancreas transplants having been a pancreas transplant alone. Our study aimed to quantify outcomes following pancreas transplant alone in the United States from 2001 to 2020, with an emphasis on graft and patient survival. Methods and materials We performed a retrospective registry analysis utilizing the OPTN/UNOS database for pancreas transplants alone performed in the United States from January 2001 to May 2020 to assess transplant outcomes. The study population was divided into two subgroups: patients receiving a pancreas transplant between 2000 and 2009 and those receiving a pancreas transplant between 2010 and 2020. Results 3008 allograft recipients were included in the study. 1679 (54.87%) transplants were done from January 2000 to the end of 2009. 1381 (45.13%) transplants were done from 2010 to May 2020. Although the BMI and recipient sex comparison indicate a statistically significant difference, the differences are not clinically significant. The overall 5‐year allograft survival rate was 52.17% in the 2000–2009 group, which increased to 58.82% in pancreas transplants alone from 2010 to 2020 (P = 0.02). The overall 5‐year patient survival rate was 74.52% in the 2000–2009 group, which increased to 74.92% in pancreas transplants alone from 2010 to 2020 (P = 0.81). Conclusion With all the progress in terms of surgical techniques, organ allocation and preservation, and immunosuppressive regimens, the pancreas transplant alone allograft survival has been improving over the years, although it has been still being underutilized around the US.

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“…Although prospective, randomized trials comparing pancreas transplantation with other state-of-the-art treatments for diabetes are lacking and would better define its role in the management algorithm, pancreas transplantation currently remains the most effective and reliable means of achieving sustained euglycemia while preventing hypoglycemia and ketoacidosis, normalizing hemoglobin A1c levels, and optimizing time in range when compared with modern alternatives. 24,25 It is important to note that pancreas transplantation provides not only insulin production but also counter regulatory secretion and exocrine function as well. Patients with a functioning pancreas transplant remain our most important ambassadors for moving the field forward because of the transformative aspects of rendering individuals not only insulin-free but also free from dietary and activity restrictions and the need to check serum glucose levels.…”

Section: Proposed Solutionsmentioning

confidence: 99%