People with diabetes may benefit more from a pancreas transplant than other treatments

WASHINGTON—Results of pancreas transplantation continue to improve and up to 90% of recipients with diabetes enjoy freedom from both insulin therapy and the need for close glucose monitoring following the procedure, according to a new paper published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.

Pancreas transplantation is a type of surgery in which a person with diabetes receives a healthy donor pancreas while the natural pancreas is not removed. People with a successful pancreas transplant no longer need insulin and have good blood sugar control. The tradeoff is that it is a major surgical procedure and requires patients to take medications to partially suppress their immune system for the rest of their lives.

“A pancreas transplant mitigates changes in blood sugar levels, eliminates the daily stigma and burden of diabetes, restores normal blood sugar regulation in patients with complicated diabetes, and improves quality of life and life expectancy,” said Jonathan A. Fridell, M.D., Chief, Abdominal Transplant Surgery of the Indiana University School of Medicine in Indianapolis, Ind. “Despite steadily improving outcomes coupled with expanded patient selection criteria to include some patients with type 2 diabetes, a decline in pancreas transplant surgeries has occurred in recent years.”

Patients who have a successful pancreas transplant can achieve better glucose control beyond what can be achieved with any other form of diabetes therapy to date. However, the number of transplants has declined due to several factors, including a lack of a primary referral source and general acceptance by the diabetes care community; an absence of consensus criteria; and access, education, and resource issues within the transplant community.

“More patients with diabetes who are failing insulin therapy or experiencing progressive diabetic complications regardless of diabetes type should be considered for a pancreas transplant,” Fridell said. “All patients with diabetes and chronic kidney disease should undergo consideration for combined kidney and pancreas transplantation independent of geography or location.”

The other authors of this paper are Robert J. Stratta, M.D., of Atrium Health Wake Forest Baptist in Winston-Salem, N.C., and Angelika Gruessner, Ph.D., of SUNY Downstate Medical Center in Brooklyn, N.Y.

The paper received no external funding.

The manuscript, “Pancreas Transplantation: Current Challenges, Considerations, and Controversies,” was published online, ahead of print.

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