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

Research output: Contribution to journalArticle

33 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)44-50
Number of pages7
JournalThe review of diabetic studies : RDS
Volume8
Issue number1
DOIs
Publication statusPublished - 2011

Fingerprint

Pancreas Transplantation
Islets of Langerhans Transplantation
Type 1 Diabetes Mellitus
Pancreas
Transplantation
Insulin
Tacrolimus
Decision Making
Hospitalization
Cardiovascular Diseases
Glucose
Infection

Keywords

  • Diabetes complications
  • Islet transplantation
  • Pancreas transplantation
  • Type 1 diabetes

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology
  • Internal Medicine
  • Medicine(all)

Cite this

Risks and benefits of transplantation in the cure of type 1 diabetes : Whole pancreas versus islet transplantation. A single center study. / Maffi, Paola; Scavini, Marina; Socci, Carlo; Piemonti, Lorenzo; Caldara, Rossana; Gremizzi, Chiara; Melzi, Raffaella; Nano, Rita; Orsenigo, Elena; Venturini, Massimo; Staudacher, Carlo; del Maschio, Alessandro; Secchi, Antonio.

In: The review of diabetic studies : RDS, Vol. 8, No. 1, 2011, p. 44-50.

Research output: Contribution to journalArticle

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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.",
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AU - Piemonti, Lorenzo

AU - Caldara, Rossana

AU - Gremizzi, Chiara

AU - Melzi, Raffaella

AU - Nano, Rita

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AU - Venturini, Massimo

AU - Staudacher, Carlo

AU - del Maschio, Alessandro

AU - Secchi, Antonio

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N2 - 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.

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