Review

Risks and Benefits of Transplantation in the Cure of Type 1 Diabetes: Whole Pancreas Versus Islet Transplantation. A Single Center Study

Paola Maffi, Marina Scavini, Carlo Socci, Lorenzo Piemonti, Rossana Caldara, Chiara Gremizzi, Raffaella Melzi, Rita Nano, Elena Orsenigo, Massimo Venturini, Carlo Staudacher, Alessandro Del Maschio, Antonio Secchi

Manuscript submitted April 28, 2011; resubmitted May 3, 2011; accepted May 7, 2011.

Keywords: pancreas transplantation, islet transplantation, diabetes complications, type 1 diabetes

Abstract

BACKGROUND: Pancreas and islet transplantation are the only available options to replace beta-cell function in patients with type 1 diabetes. Great variability in terms of rate of success for both approaches is reported in the literature and it is difficult to compare the respective risks and benefits. OBJECTIVES: The aim of this study was to analyze risks and benefits of pancreas transplantation alone (PTA) and islet transplantation alone (ITA) by making use of the long-term experience of a single center where both transplantations are performed. We focused on the risks and benefits of both procedures, with the objective of better defining indications and providing evidence to support the decision-making process. The outcomes of 33 PTA and 33 ITA were analyzed, and pancreas and islet function (i.e., insulin independence), perioperative events, and long-term adverse events were recorded. RESULTS: We observed a higher rate of insulin independence in PTA (75%) versus ITA (59%), with the longer insulin independence among PTA patients receiving tacrolimus. The occurrence of adverse events was higher for PTA patients in terms of hospitalization length and frequency, re-intervention for surgical and immunological acute complications, CMV reactivation, and other infections. CONCLUSIONS: In conclusion, these results support the practice of listing patients for PTA when the metabolic control and the progression of chronic complications require a rapid normalization of glucose levels, with the exception of patients with cardiovascular disease, because of the high surgical risks. ITA is indicated when replacement of beta-cell mass is needed in patients with a high surgical risk.

Fulltext: HTML , PDF (316KB)

This article has been cited by other articles:

	Current progress in xenotransplantation and organ bioengineering Michel SG, Madariaga ML, Villani V, Shanmugarajah K Int J Surg 2015. 13C:239-244
	MR imaging monitoring of iron labeled pancreatic islets in a small series of patients: islets fate in successful, unsuccessful and auto-transplantation Malosio ML, Esposito A, Brigatti C, Palmisano A, Piemonti L, Nano R, Maffi P, De Cobelli F, Del Maschio A, Secchi A Cell Transplant 2014. In press
	Impact of islet size on pancreatic islet transplantation and potential interventions to improve outcome Zorzi D, Phan T, Sequi M, Lin Y, Freeman DH, Cicalese L, Rastellini C Cell Transplant 2015. 24(1):11-23
	Management of brittle diabetes Darias-Garzon R, Garcia-Bray BF, Gomez-Alvarez B Acances Diabetol 2014. 30(6):167-172
	The allocation of pancreas allografts on donor age and duration of intensive care unit stay: the experience of the North Italy Transplant program Cardillo M, Nano R, de Fazio N, Melzi R, Drago F, Mercalli A, Dell'Acqua A, Scavini M, Piemonti L Transpl Int 2014. 27(4):353-361
	Benefits of healthy adipose tissue in the treatment of diabetes Gunawardana SC World J Diabetes 2014. 5(4):420-430
	Novel T-cell inhibiting peptides delay the onset of Type 1 diabetes in non-obese diabetic mice Wong MS, Tso A, Ali M, Hawthorne WJ, Manolios N Diabetes Metab 2014. 40(3):229-234
	Treating diabetes with islet transplantation: lessons from the past decade in Lille Vantyghem MC, Defrance F, Quintin D, Leroy C, Raverdi V, Prevost G, Caiazzo R, Kerr-Conte J, Glowacki F, Hazzan M, Noel C, Pattou F, Diamenord AS, Bresson R, Bourdelle-Hego MF, et al. Diabetes Metab 2014. 40(2):108-119
	Islet transplantation stabilizes hemostatic abnormalities and cerebral metabolism in individuals with type 1 diabetes D'Addio F, Maffi P, Vezzulli P, Vergani A, Mello A, Bassi R, Nano R, Falautano M, Coppi E, Finzi G, D'Angelo A, Fermo I, Pellegatta F, La Rosa S, Magnani G, Piemonti L, Falini A, Folli F, Secchi A, Fiorina P Diabetes Care. 2014. 37(1):267-276
	Simultaneous kidney and pancreas transplantation in patients with type 1 diabetes mellitus at Clinica Fundacion Valle del Lily, Cali, Colombia Serrano OJ, Villegas JI, Echeverri GJ, Posada JG, Mesa L, Schweineberg J, Duran C, Caicedo LA Rev Colomb Cir 2014. 29:32-41
	The current state of pancreas transplantation Gruessner RW, Gruessner AC Nat Rev Endocrinol 2013. 9(9):555-562
	Pancreas transplant alone: a procedure coming of age Gruessner RW, Gruessner AC Diabetes Care 2013. 36(8):2440-2447
	Why is organ transplantation clinically important? Grinyo JM Cold Spring Harb Perspect Med 2013. 3(6):a014985
	Pancreatic islet transplantation in type 1 diabetes mellitus: an update on recent developments Ramesh A, Chhabra P, Brayman KL Curr Diabetes Rev 2013. 9(4):294-311
	Perceptions of diabetes in rural areas of Eastern Uganda Rutebemberwa E, Katureebe SK, Gitta SN, Mwaka AD, Atuyambe L Curationis 2013. 36(1):E1-E7
	Heterogeneous islet transplantation via hepatic artery versus portal vein for type I diabetes in rhesus monkeys Ye B, Liao J, Nie W, Liang Q, Dong Q, Ma XQ, Wang W, Liu S Chin J Tissue Engin Res 2012. 16(18):3285-3289
	Adipose tissue, hormones, and treatment of type 1 diabetes Gunawardana SC Curr Diab Rep 2012. 12(5):542-550
	Case report: gastrointestinal hemorrhage caused by a pancreas transplant arteriovenous fistula with large psuedoanuerysm 9 years after transplantation Bratton CF, Hamid A, Selby JB, Baliga PK Transplant Proc 2011. 43(10):4039-4043