A Comparative Study of Pancreas Transplantation Between Type 1 and 2 Diabetes Mellitus

Overview

Journal Hepatobiliary Surg Nutr

Publisher AME Publishing Company

Date 2021 Aug 25

PMID 34430523

Authors

Bor-Shiuan Shyr

Bor-Uei Shyr

Shih-Chin Chen

Che-Chuan Loong

Yi-Ming Shyr

Shin-E Wang

Affiliations

Soon will be listed here.

Abstract

Background: Pancreas transplantation remains the best long-term treatment option to achieve physiological euglycemia and insulin independence in patients with labile diabetes mellitus (DM). It is widely accepted as an optimal procedure for type 1 DM (T1DM), but its application in type 2 DM (T2DM) is not unanimously acknowledged.

Methods: In total, 146 diabetes patients undergoing pancreas transplantation were included in this study. Clinical data and outcomes were compared between the T1DM and T2DM groups.

Results: Majority (93%) of the pancreas transplantations in T2DM were for uremic recipients. Complications occurred in 106 (73%) patients, including 70 (48%) with early complications before discharge and 79 (54%) with late complications during follow-up period. Overall, rejection of pancreas graft occurred in 37 (25%) patients. Total rejection rate in T2DM recipients was significantly lower than that in T1DM. The short- and long-term outcomes for endocrine function in terms of fasting blood sugar and hemoglobin A1c levels and graft survival rates are comparable between the T2DM and T1DM groups.

Conclusions: T2DM is not inferior to T1DM after pancreas transplantation in terms of surgical risks, immunological and endocrine outcomes, and graft survival rates. Therefore, pancreas transplantation could be an effective option to treat selected uremic T2DM patients without significant insulin resistance.

References

Chakkera H, Bodner J, Heilman R, Mulligan D, Moss A, Mekeel K . Outcomes after simultaneous pancreas and kidney transplantation and the discriminative ability of the C-peptide measurement pretransplant among type 1 and type 2 diabetes mellitus. Transplant Proc. 2010; 42(7):2650-2. PMC: 3060052. DOI: 10.1016/j.transproceed.2010.04.065. View

Al-Qaoud T, Odorico J, Redfield 3rd R . Pancreas transplantation in type 2 diabetes: expanding the criteria. Curr Opin Organ Transplant. 2018; 23(4):454-460. DOI: 10.1097/MOT.0000000000000553. View

Margreiter C, Resch T, Oberhuber R, Aigner F, Maier H, Sucher R . Combined pancreas-kidney transplantation for patients with end-stage nephropathy caused by type-2 diabetes mellitus. Transplantation. 2013; 95(8):1030-6. DOI: 10.1097/TP.0b013e3182861945. View

Kandaswamy R, Stock P, Gustafson S, Skeans M, Curry M, Prentice M . OPTN/SRTR 2015 Annual Data Report: Pancreas. Am J Transplant. 2017; 17 Suppl 1:117-173. DOI: 10.1111/ajt.14125. View

Gruessner A, Laftavi M, Pankewycz O, Gruessner R . Simultaneous Pancreas and Kidney Transplantation-Is It a Treatment Option for Patients With Type 2 Diabetes Mellitus? An Analysis of the International Pancreas Transplant Registry. Curr Diab Rep. 2017; 17(6):44. DOI: 10.1007/s11892-017-0864-5. View

Fourtounas C . Transplant options for patients with type 2 diabetes and chronic kidney disease. World J Transplant. 2014; 4(2):102-10. PMC: 4094945. DOI: 10.5500/wjt.v4.i2.102. View

Gondolesi G, Aguirre N, Ramisch D, Mos F, Pedraza N, Fortunato M . Pancreas Transplantation at a Single Latin-American Center; Overall Results with Type 1 and Type 2 Diabetes Mellitus. Transplant Proc. 2018; 50(5):1475-1481. DOI: 10.1016/j.transproceed.2018.03.022. View

Gruessner A, Gruessner R . Pancreas Transplantation of US and Non-US Cases from 2005 to 2014 as Reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR). Rev Diabet Stud. 2016; 13(1):35-58. PMC: 5291181. DOI: 10.1900/RDS.2016.13.35. View

Kandaswamy R, Stock P, Gustafson S, Skeans M, Curry M, Prentice M . OPTN/SRTR 2016 Annual Data Report: Pancreas. Am J Transplant. 2018; 18 Suppl 1:114-171. DOI: 10.1111/ajt.14558. View

10.

Sampaio M, Kuo H, Bunnapradist S . Outcomes of simultaneous pancreas-kidney transplantation in type 2 diabetic recipients. Clin J Am Soc Nephrol. 2011; 6(5):1198-206. PMC: 3087789. DOI: 10.2215/CJN.06860810. View

11.

Cohen D, Ratner L . Type 2 diabetes: the best transplant option is still uncertain. Clin J Am Soc Nephrol. 2012; 7(4):530-2. DOI: 10.2215/CJN.02120212. View

12.

Gruessner A, Gruessner R . Pancreas Transplantation for Patients with Type 1 and Type 2 Diabetes Mellitus in the United States: A Registry Report. Gastroenterol Clin North Am. 2018; 47(2):417-441. DOI: 10.1016/j.gtc.2018.01.009. View

13.

Nath D, Gruessner A, Kandaswamy R, Gruessner R, Sutherland D, Humar A . Outcomes of pancreas transplants for patients with type 2 diabetes mellitus. Clin Transplant. 2005; 19(6):792-7. DOI: 10.1111/j.1399-0012.2005.00423.x. View

14.

Ciancio G, Burke G . Type 2 diabetes: is pancreas transplantation an option?. Curr Diab Rep. 2014; 14(11):542. DOI: 10.1007/s11892-014-0542-9. View

15.

Light J, Barhyte D . Simultaneous pancreas-kidney transplants in type I and type II diabetic patients with end-stage renal disease: similar 10-year outcomes. Transplant Proc. 2005; 37(2):1283-4. DOI: 10.1016/j.transproceed.2004.12.215. View

16.

Singh R, Rogers J, Farney A, Hartmann E, Reeves-Daniel A, Doares W . Do pretransplant C-peptide levels influence outcomes in simultaneous kidney-pancreas transplantation?. Transplant Proc. 2008; 40(2):510-2. DOI: 10.1016/j.transproceed.2008.01.048. View

17.

Rohan V, Taber D, Palanisamy A, McGillicuddy J, Chavin K, Baliga P . Impact of Type 1 and Type 2 Diabetes Mellitus on Pancreas Transplant Outcomes. Exp Clin Transplant. 2018; 17(6):796-802. DOI: 10.6002/ect.2017.0296. View

18.

Kaufman D, Sutherland D . Simultaneous pancreas-kidney transplants are appropriate in insulin-treated candidates with uremia regardless of diabetes type. Clin J Am Soc Nephrol. 2011; 6(5):957-9. DOI: 10.2215/CJN.03180411. View

19.

Weems P, Cooper M . Pancreas transplantation in type II diabetes mellitus. World J Transplant. 2014; 4(4):216-21. PMC: 4274592. DOI: 10.5500/wjt.v4.i4.216. View

20.

Orlando G, Stratta R, Light J . Pancreas transplantation for type 2 diabetes mellitus. Curr Opin Organ Transplant. 2010; 16(1):110-5. DOI: 10.1097/MOT.0b013e3283424d1f. View