Pancreas and Islet Transplantation
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee
Breay W. Paty MD, FRCPC Angela Koh MD Peter Senior MBBS, PhD, MRCP
Simultaneous pancreas kidney transplantation in persons with type 1 diabetes and end stage renal disease can improve kidney graft survival and result in prolonged insulin independence.
Successful pancreas or islet allotransplantation can stabilize glucose and possibly result in insulin independence in persons with type 1 diabetes and glycemic lability or recurrent hypoglycemia.
Islet autotransplantation can stabilize glucose and possibly result in insulin independence in people undergoing total pancreatectomy for benign pancreatic disease.
Highlights of Revisions
A new recommendation has been added regarding individuals undergoing total pancreatectomy for benign pancreatic disease.
Individuals with type 1 diabetes and ESRD who are being considered for kidney transplantation should also be considered for simultaneous pancreas transplantation [Grade D, Level 4 (1,2)].
Individuals with type 1 diabetes with preserved renal function, or who have undergone successful kidney transplantation but have persistent metabolic instability characterized by severe glycemic lability and/or severe hypoglycemia despite best efforts to optimize glycemic control, may be considered for pancreas or islet allotransplantation [Grade D, Consensus].
Individuals undergoing total pancreatectomy for benign pancreatic disease may be considered for islet autotransplantation but only in the context of an experienced islet transplantation centre [Grade D, Consensus].
ESRD, end stage renal disease.
Ojo AO, Meier-Kriesche HU, Hanson JA, et al. The impact of simultaneous pancreas-kidney transplantation on long-term patient survival. Transplantation 2001;71:82-90.
Weiss AS, Smits G, Wiseman AC. Twelve-month pancreas graft function significantly influences survival following simultaneous pancreas-kidney transplantation. Clin J Am Soc Nephrol 2009;4:988-95.
Reproduced with permission from Canadian Journal of Diabetes
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