Anne L. Peters, MD, CDE; Michael R. Rickels, MD

Disclosures

June 28, 2013

In This Article

The Outlook for Transplantation

Dr. Peters: What is new at the ADA meeting this year in this field? Have we learned anything to push this further along?

Dr. Rickels: Outcomes for whole pancreas transplantation have continued to improve, so we are doing a better job in both minimizing technical losses of pancreas grafts in the early postoperative period, as well as having lower rates of immunologic graft loss, whether to recurrent autoimmunity or alloimmune rejection. The long-term outlook for whole pancreas transplantation is getting better for our patients.

The group of patients who receive a pancreas by itself has always had a much higher rate of immunologic graft loss and has benefitted from the advances in immunosuppression therapy. We have been able to get much greater gains in the longevity in the function of those transplants.

Dr. Peters: If a patient comes to me and wants an islet cell transplant, something that I am asked all the time, what should I say? How do you decide who you would refer for a whole organ pancreas transplant?

Dr. Rickels: Right now, for patients experiencing severe problems with hypoglycemia, whole organ pancreas transplantation is an available option. My recommendation would be to seek consultation at an experienced center that does a high volume of whole pancreas transplants. With respect to islet cell transplantation, right now there are centers involved with the Clinical Islet Transplantation Consortium that have experimental protocols. Patients who have had a kidney transplant might be candidates for islet transplantation. That would be a consideration to potentially avoid the commitment to a second major surgical operation for the treatment of diabetes.

Dr. Peters: To be eligible, they must already have undergone a kidney transplant, so I can't just send somebody out to have some islets and get cured? It's not there yet?

Dr. Rickels: We are not there yet.

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