2005 Update: Impact of pancreas and islet transplants on acute and chronic complications of diabetes

Purpose of review: To provide updated information about the consequences of successful islet transplantation on the acute and chronic complications of diabetes in the context of success rates experienced with pancreas transplantation. Recent findings: Pancreas transplantation is well recognized to normalize blood glucose and HbA1c levels in type 1 diabetic recipients. Since the year 2000, this has become true for islet transplantation, also. When successful, both procedures virtually eliminate the risks of diabetic ketoacidosis, hyperosmolar coma, and recurrent hypoglycemia caused by exogenous insulin use. Pancreas, but not intrahepatic islet, transplantation also provides normal hypoglycemia-responsive glucagon secretion. Although insufficient data exist for islet transplant recipients to evaluate the effects of this procedure on chronic complications of diabetes, pancreas transplantation has been reported to stabilize retinopathy, nephropathy, neuropathy, and macrovasular disease, as well as to improve quality of life indices, including patient survival. The organ survival rate for pancreas transplantation is currently much longer than the rate for islet transplantation. Summary: Although severely limited by the availability of donated pancreases, both procedures can be considered as efficacious therapeutic alternatives in selected patients. Pancreas transplantation, however, currently is the more efficacious procedure.