Pancreas vs. Islet Transplantation: the False Dilemma
- PDF / 409,676 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 47 Downloads / 200 Views
CELLULAR TRANSPLANTS (G ORLANDO, SECTION EDITOR)
Pancreas vs. Islet Transplantation: the False Dilemma Martin Wijkstrom 1 Accepted: 7 October 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose of Review Pancreas and islet cell transplantation are the only treatment modalities that can restore euglycemia and allow freedom from hypoglycemic events. Transplantation for diabetes has decreased in the USA over the last 6 years due to several factors. Reasons for this and possible future paths will be explored. Recent Findings Clinical application of islet transplantation is mostly limited by regulatory hurdles in the USA. The limitations of pancreas transplantation are multifactorial and more nuanced. Both types of transplants are limited by the number of suitable organ donors; however, pancreas and islet transplantation do not compete for the same organs. Only 10.7% of available pancreata are currently being utilized for clinical application. Summary Current technology if utilized more efficiently could significantly increase the available donor pancreata for both whole organ and islets. Considering that severely diseased pancreata are routinely processed for islets and subsequent transplanted in chronic pancreatitis patients, and have significant metabolic impact in these patients, there is an opportunity to widen the organ use beyond what is currently done. Optimizing access to β-cell replacement therapy has significant potential to improve outcomes for carefully selected patients. Keywords Islet transplantation . Pancreas transplantation . Allotransplantation, islet autotransplantation . Type 1 diabetes . Pancreas allocation
Abbreviations ALT Alanine aminotransferase AST Aspartate aminotransferase BLA Biological License Application BMI Body mass index BUN Blood urea nitrogen CITR Collaborative Islet Transplant Registry CIT Clinical Islet Transplant Consortium Consortium DBD Donation after brain death DCD Donation after circulatory death HbA1c Glycated hemoglobin IAK Islet transplant after kidney transplant IPTR International Pancreas Transplant Registry IS Immunosuppression This article is part of the Topical Collection on Cellular Transplants * Martin Wijkstrom [email protected] 1
Department of Surgery, Division of Transplantation, University of Pittsburgh, 200 Lothrop Street, MUH 7 South, Pittsburgh, PA 15213, USA
ITA OPTN PAK PDRI PTA SPK SRTR T1DM T2DM UW
Islet transplant alone Organ Procurement and Transplantation Network Pancreas after kidney transplant Pancreas donor risk index Pancreas transplant alone Simultaneous pancreas kidney transplant Scientific Registry of Transplant Recipients Type 1 diabetes mellitus Type 2 diabetes mellitus University of Wisconsin
Introduction Optimal medical therapy for type 1 diabetic mellitus (T1DM) is evolving. For most patients, the combination of modern insulin pump therapy and continuous glucose monitoring is adequate. Goal glycemic control (HbA1c ≤ 7.0%) can be achieved with limited end-organ damage in the majority of T1DM patients. However, transplantati
Data Loading...
