Pancreas transplantation: State of the art and future prospects

Authors: František Saudek 1,2;  Peter Girman 1,2;  Květoslav Lipár 3;  Petr Bouček 1,2;  Radka Kožnarová 1,2;  Matěj Kočík 3
Authors‘ workplace: Klinika diabetologie IKEM Praha, přednosta prof. MUDr. František Saudek, DrSc. 1;  Centrum diabetologie, přednostka prof. MUDr. Terezie Pelikánová, DrSc. 2;  Klinika transplantační chirurgie IKEM Praha, přednosta doc. MUDr. Jiří Froněk, Ph. D., FRCS 3
Published in: Vnitř Lék 2015; 61(7-8): 731-737
Category: Vanýsek´s day 2015


During the past 30 years pancreas transplantation evolved into a routine procedure especially suitable for type 1 diabetic recipients undergoing simultaneously kidney transplantation significantly improving quality of life and life expectancy as compared with kidney only recipients. It provides insulin independence with near-normal glucose control without special dietary restriction, freedom from hypoglycemia and chance for halting or regression of microangiopathic diabetes complications. As a separate procedure, pancreas transplantation is carried out mainly in selected subjects suffering from severe hypoglycemic episodes and impaired hypoglycemia awareness or as a subsequent procedure in type 1 diabetic kidney recipients from both cadaveric or living donors. Five-year insulin independence rate following combined pancreas and kidney, pancreas only and pancreas after kidney procedures currently exceed 75, 50 and 62 %, respectively. Though the outcomes still continue to improve, the rate of pancreas transplants has reached a plateau in several European countries or even declines in the United States. Main reasons for that include fewer referrals from diabetes specialist, decreased donor quality, introduction of islet transplantation as a less invasive procedure but probably most of all probably insufficient information on the latest progress and trends achieved in this area. In the area of transplant therapy of diabetes Czech Republic traditionally ranks to the most active countries providing different transplant options according to individual clinical needs including islet transplantation.

Key words:
diabetes mellitus – diabetic nephropathy – immunosuppression – kidney transplantation – pancreas transplantation


1. Nathan DM, Cleary PA, Backlund JY et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 2005; 353(25): 2643–2653.

2. Orchard TJ, Nathan DM, Zinman B et al. Writing Group for the DCCT/EDIC Research Group. Association between 7 years of intensive treatment of type 1 diabetes and long-term mortality. JAMA 2015; 313(1): 45–53.

3. Stadler M, Peric S, Strohner-Kaestenbauer H et al. Mortality and incidence of renal replacement therapy in people with type 1 diabetes mellitus – a three decade long prospective observational study in the Lainz T1DM cohort. J Clin Endocrinol Metab 2014; 99(12): 4523–4530.

4. Weinstock RS, Xing D, Maahs DM et al. Severe hypoglycemia and diabetic ketoacidosis in adults with type 1 diabetes: results from the T1D Exchange clinic registry. J Clin Endocrinol Metab 2013; 98(8): 3411–3419.

5. Sollinger HW, Odorico JS, Becker YT et al. One thousand simultaneous pancreas-kidney transplants at a single center with 22-year follow-up. Ann Surg 2009; 250(4): 618–630.

6. Girman P, Saudek F. The IKEM pancreas and islet transplant program as part of healthcare for type 1 diabetes patients: retrospective analysis of outcome from 1983 to 2010. Rev Diabet Stud 2011; 8(1): 35–43.

7. Boggi U, Rosati CM, Marchetti P. Follow-up of secondary diabetic complications after pancreas transplantation. Curr Opin Organ Transplant 2013; 18(1): 102–110.

8. Morath C, Zeier M, Döhler B et al. Transplantation of the type 1 diabetic patient: the long-term benefit of a functioning pancreas allograft. Clin J Am Soc Nephrol 2010; 5(3): 549–552.

9. Frier BM. Hypoglycaemia in diabetes mellitus: epidemiology and clinical implications. Nat Rev Endocrinol 2014; 10(12): 711–722.

10. Skrivarhaug T, Bangstad HJ, Stene LC et al. Long-term mortality in a nationwide cohort of childhood-onset type 1 diabetic patients in Norway. Diabetologia 2006; 49(2): 298–305.

11. Feltbower RG, Bodansky HJ, Patterson CC et al. Acute complications and drug misuse are important causes of death for children and young adults with type 1 diabetes: results from the Yorkshire Register of diabetes in children and young adults. Diabetes Care 2008; 31(5): 922–926.

12. Sherr J, Tamborlane WV, Xing D et al. Achievement of target A1C levels with negligible hypoglycemia and low glucose variability in youth with short-term type 1 diabetes and residual beta-cell function. Diabetes Care 2012; 35(4): 817–820.

13. Rickels MR, Fuller C, Dalton-Bakes C et al. Restoration of Glucose Counterregulation by Islet Transplantation in Long-Standing Type 1 Diabetes. Diabetes 2015; 64(5): 1713–1718. Dostupné z DOI: <–1620>.

14. Lipar K, Adamec M. Development of pancreas transplantation surgical techniques in IKEM. Rozhl Chir 2011; 90(2): 127–129.

15. Saudek F. Transplantation in the treatment of diabetes. Vnitř Lék 2007; 53(7–8): 859–864.

16. Kandaswamy R, Skeans MA, Gustafson SK et al. OPTN/SRTR 2013 Annual Data Report: Pancreas. Am J Transplant 2015; 15(Suppl 2): 1–20.

17. Girman P, Lipar K, Koznarova R et al. Similar early complication rate in simultaneous pancreas and kidney recipients on tacrolimus/mycophenolate mofetil versus tacrolimus/sirolimus immunosuppressive regimens. Transplant Proc 2010; 42(6): 1999–2002.

18. Reutens AT. Epidemiology of diabetic kidney disease. Med Clin North Am 2013; 97(1): 1–18.

19. Russell SJ, El-Khatib FH, Sinha M et al. Outpatient glycemic control with a bionic pancreas in type 1 diabetes. N Engl J Med 2014; 371(4): 313–325.

20. Light JA, Barhyte DY. Simultaneous pancreas-kidney transplants in type I and type II diabetic patients with end-stage renal disease: similar 10-year outcomes. Transplant Proc 2005; 37(2): 1283–1284.

21. Saudek F, Průhová S, Boucek P et al. Maturity-onset diabetes of the young with end-stage nephropathy: a new indication for simultaneous pancreas and kidney transplantation? Transplantation 2004; 77(8): 1298–12301.

22. Ciancio G, Burke GW. Type 2 diabetes: is pancreas transplantation an option? Curr Diab Rep 2014; 14(11): 542.

23. Burrows NR, Li Y, Geiss LS. Incidence of treatment for end-stage renal disease among individuals with diabetes in the U.S. continues to decline. Diabetes Care 2010; 33(1): 73–77.

24. Siskind E, Maloney C, Akerman M et al. An analysis of pancreas transplantation outcomes based on age groupings – an update of the UNOS database. Clin Transplant 2014; 28(9): 990–994.

25. Fridell JA, Mangus RS, Hollinger EF et al. The case for pancreas after kidney transplantation. Clin Transplant 2009; 23(4): 447–453.

26. Philosophe B, Farney AC, Schweitzer EJ et al. Simultaneous pancreas-kidney (SPK) and pancreas living-donor kidney (SPLK) transplantation at the University of Maryland. Clin Transpl 2000: 211–216.

27. Farney AC, Cho E, Schweitzer EJ et al. Simultaneous cadaver pancreas living-donor kidney transplantation: a new approach for the type 1 diabetic uremic patient. Ann Surg 2000; 232(5): 696–703.

28. Nathan DM, Bayless M, Cleary P et al. Diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years: advances and contributions. Diabetes 2013; 62(12): 3976–3986.

29. Gruessner RW, Gruessner AC. Pancreas transplant alone: a procedure coming of age. Diabetes Care 2013; 36(8): 2440–2447.

30. Byrne ML, Hopkins D, Littlejohn W et al. Outcomes for adults with type 1 diabetes referred with severe hypoglycaemia and/or referred for islet transplantation to a specialist hypoglycaemia service. Horm Metab Res 2015; 47(1): 9–15.

31. Kim SJ, Smail N, Paraskevas S et al. Kidney function before pancreas transplant alone predicts subsequent risk of end-stage renal disease. Transplantation 2014; 97(6): 675–680.

32. Fioretto P, Mauer M. Effects of pancreas transplantation on the prevention and reversal of diabetic nephropathy. Contrib Nephrol 2011; 170: 237–246. Dostupné z DOI: <>.

33. Boggi U, Vistoli F, Signori S et al. A technique for retroperitoneal pancreas transplantation with portal-enteric drainage. Transplantation 2005; 79(9): 1137–1142.

34. Niederhaus SV, Leverson GE, Lorentzen DF et al. Acute cellular and antibody-mediated rejection of the pancreas allograft: incidence, risk factors and outcomes. Am J Transplant 2013; 13(11): 2945–2955.

35. Dong M, Parsaik AK, Kremers W et al. Acute pancreas allograft rejection is associated with increased risk of graft failure in pancreas transplantation. Am J Transplant 2013; 13(4): 1019–1025.

36. Mittal S, Page SL, Friend PJ et al. De novo donor-specific HLA antibodies: biomarkers of pancreas transplant failure. Am J Transplant 2014; 14(7): 1664–1671.

37. de Kort H, Roufosse C, Bajema IM et al. Pancreas transplantation, antibodies and rejection: where do we stand? Curr Opin Organ Transplant 2013; 18(3): 337–344.

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