Pancreas transplantation at the time of renal transplantation is becoming more widely accepted. Patients undergoing simultaneous pancreas and kidney transplantation have an 85% chance of pancreatic graft survival and a 92% chance of renal graft survival after 1 year. Solitary pancreatic transplantation in the absence of a need for renal transplantation should be considered only in those rare patients who fail all other insulin therapeutic approaches and who have frequent severe hypoglycemia or who have life-threatening complications related to their lack of metabolic control.
Islet cell transplantation is a minimally invasive procedure, and investigators in Edmonton, Canada, have reported initial insulin independence in a small number of patients with type 1 diabetes who underwent this procedure.
Using islets from multiple donors and corticosteroid-free immunosuppression, percutaneous transhepatic portal vein transplantation of islets was achieved in over 20 subjects. Although all of the initial cohort was able to achieve insulin independence posttransplantation (some for more than 2 years of follow-up), a decline in insulin secretion has occurred over time and the subjects have again required supplemental insulin. All patients had complete correction of severe hypoglycemic reactions, leading to a marked improvement in overall quality of life. Even if long-term insulin independence is demonstrated, wide application of this procedure for the treatment of type 1 diabetes is limited by the dependence on multiple donors and the requirement for potent long-term immunotherapy.
Extent and duration of action of various types of insulin-euglycemic hyperinsulinemic clamps in normal volunteers. A: Intermediate neutral protamine Hagedorn (NPH) insulin and long-acting insulin analogs. B: Regular insulin and rapid-acting insulin analogs.0.0156249