Pancreas Transplant for Diabetics

Pancreatic transplantation is done as a therapeutic option for patients with complicated type 1 diabetes, but whether this transplant is effective has been controversial.

Now, a new study finds patients who receive a pancreas transplant appear to have worse survival than patients on the transplant waiting list who received conventional therapy.

The American Diabetic Association supports a pancreatic transplant for patients who have had or need a kidney transplant. However, in the absence of kidney failure, pancreas transplantation may be considered for diabetics who have severe diabetes with frequent episodes of very low or very high blood glucose levels. Researchers from Department of Health and Human Services conducted a study to compare the survival of pancreas transplant recipients with those on the waiting list. The study used information from 124 transplant centers in the United States. Researchers included information on 11,572 patients. The patients were followed for four years.

Researchers say the patients who had pancreas transplants had a 57-percent increased risk of death compared with the patients awaiting the same procedure. In patients who had a pancreas transplant following a kidney transplant, there was a 42-percent increased risk of death. Researchers also report a 57-percent decreased risk of death for patients who had a simultaneous pancreas-kidney transplant. Based on the study the data collected suggests that patients with complicated diabetes who are considering a solitary pancreas transplant must weigh the potential benefit of insulin independence against an apparent increase in mortality for at least the first four years post-transplantation.

Researchers conclude clinicians and patients considering a pancreas transplant option need to understand the actual risks and benefits, the expense, and the uncertainties with this surgical therapy.

In an accompanying editorial, doctors from Massachusetts General Hospital and Harvard Medical School say this study has important implications. They say the increased early mortality should temper the enthusiasm for pancreas transplant alone. They point out since patients on the waiting list had improved survival, that shows how routine care of diabetes have improved the long-term outlook for all diabetic patients.