Islet Cell or Pancreas Transplantation

Islet cell or pancreas transplantation is the only long-term diabetes treatment that consistently results in normal hemoglobin A1c levels without the risk of severe hypoglycemia. Additionally, islet cell or pancreas transplantation may prevent, halt, or even reverse the complications of diabetes. Consequently, it is an important part of the management of a subset of patients with diabetes, namely, those in renal failure and those with life-threatening complications of their diabetes such as hypoglycemic unawareness. Here, we explore the indications, options, and outcomes of islet cell or pancreas transplantation as a treatment for diabetes mellitus. The morbidity of solid-organ pancreas transplantation restricts pancreas transplantation to relatively younger and fitter patients. Islet cell transplantation is less invasive and, therefore, more appealing to patients, endocrinologists, and diabetologists. Pancreas transplants and islet transplants should be considered complementary, not mutually exclusive, procedures that are chosen on the basis of the individual patient’s surgical risk. As the mortality and morbidity of solid pancreas transplantation diminish and the longer-term outcomes of both solid-organ and islet transplantation improve, the appropriate indications for both procedures will expand, particularly with the increasing incidence of diabetes as well as evidence that transplantation is suitable not only for type 1 diabetics but also for selected insulin-dependent patients with type 2 diabetes.