Special presentation
Pancreas Versus Islet Transplantation in Diabetes Mellitus: How to Allocate Deceased Donor Pancreata?

https://doi.org/10.1016/j.transproceed.2006.01.005Get rights and content

Abstract

Transplant options for the diabetic recipient include pancreas and islet transplantation. Pancreas transplantation has been increasingly performed in the last 3 decades with increasing success rates. Nevertheless, islet transplantation offers the advantage of being less invasive with fewer complications. However, current experience shows that multiple transplants are required to achieve and maintain insulin-independence in the intermediate term, and long-term function remains a problem even with multiple transplants. Early successes with single-donor islet transplants are encouraging and if maintained will largely substitute pancreas transplants. Currently, single-donor islet transplants have been shown to work in recipients with low insulin requirements who receive a pancreas from a donor with high body mass index. However, pancreas transplants from obese donors are associated with increased surgical risk. Therefore, it is logical to preferentially allocate obese donor pancreata to islet recipients. In addition, older donor (50 to 65 years) pancreata could be preferentially allocated to islets since their islet yield is still good, whereas they are associated with decreased survival in whole-organ pancreas transplants. With increasing efficiency and success of islet transplants the criteria for pancreas allocation for islets will need to be periodically reviewed.

References (18)

There are more references available in the full text version of this article.

Cited by (21)

  • Overcoming barriers in clinical islet transplantation: Current limitations and future prospects

    2014, Current Problems in Surgery
    Citation Excerpt :

    Organ allocation schemes prioritize whole-pancreas transplantation over islet transplantation.32 Currently, the Organ Procurement and Transplantation Network-United Network for Organ Sharing Kidney and Pancreas Transplant Committee preferentially allocate pancreas from older, overweight donors for islet transplantation.79,80 The underlying logic is that pancreata from older donors between 50 and 65 years of age are associated with decreased survival when utilized in whole-organ pancreas transplants; however, on account of their good islet yield, they are allocated for islet transplantation.

  • Standardization of islet isolation outcome - A new automatic system to determine pancreatic islet viability

    2011, Expert Systems with Applications
    Citation Excerpt :

    Large islets (high isolation index) are generally considered preferable as compared to smaller islets (low isolation index) since the latter could be indicative of over-digestion and fragmentation of the endocrine tissue and consequent loss of functionality. Contrarily, some investigators have recently proposed an advantage of the smaller islets due to better oxygenation and vascularization post-transplant (Cavallari, Zuellig, Lehmann, Weber, & Moritz, 2007; Kandaswamy & Sutherland, 2006; Lehmann et al., 2007; Nano et al., 2005). Based on reported evidence, purity, described as percentage of islets versus non-endocrine tissue, represents another ambiguous factor.

  • Multi-Criteria Decision Making support system for pancreatic islet transplantation

    2011, Expert Systems with Applications
    Citation Excerpt :

    Those include hypoxia, mechanic and enzymatic damage, inflammation, allo and auto immunity, immunosupression, and others. Islet size has been recently investigated in relation to graph function with conflicting conclusions (Cavallari, Zuellig, Lehmann, Weber, & Moritz, 2007; Kandaswamy & Sutherland, 2006; Lehmann et al., 2007). Islet number is a critical indicator of viability and correlates with clinical success (Mahler et al., 1999).

  • Outcomes of Extended Donors in Pancreatic Transplantation With Portal-Enteric Drainage

    2008, Transplantation Proceedings
    Citation Excerpt :

    In addition, deceased donors >50 years have increased from 21% to 31%, and cerebrovascular causes of brain death have risen from 26% to 41%.1 The lack of available pancreata is compounded not only by the overall shortage of organ donors but also by donor pancreatic under-utilization and a resurgence in islet transplantation.2–4,12–14 “Ideal” pancreatic donors are usually between the ages of 10 and 40 years, have a body weight between 30 to 80 kg, have sustained brain death due to head trauma, and have been hospitalized for <48 hours.5–8

View all citing articles on Scopus
View full text