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

  • Key Messages
  • Recommendations
  • Figures
  • Highlights
  • Full Text
  • References

Key Messages

  • 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.

Recommendations

  1. 1.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)].
  2. 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].
  3. 3.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].

Abbreviation:
ESRD, end stage renal disease.

References

  1. 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.
  2. 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 © 2013 Canadian Diabetes Association. To cite this article, please refer to For citation.

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