Current Status of Pancreas Transplantation

Transplantation of whole pancreas can restore euglycemia in patients with insulin-dependent, type 1 diabetes (T1D). It reverses diabetes in most patients, improving complications and quality of life, but requires chronic immunosuppression. Given the side effects and health risks associated with immunosuppression, exogenous insulin therapy remains the mainstay of treatment for most patients with T1D, unless patients cannot adequately control their metabolism with exogenous insulin or develop life-threatening complications (such as severe hypoglycemia and kidney failure) that can be corrected by transplantation. Pancreas transplantation (PT) is presently associated with excellent graft survival and function but requires surgery with the risk of perioperative mortality and morbidity. Thus, clinical indications and patient selection are very important. Patients with end-stage renal disease are candidates for simultaneous kidney-pancreas transplantation, which accounts for the majority of pancreas transplants. This chapter will review the current status of PT and discuss major challenges and future directions.