A Role for Transplant Endocrinologists - It's About Time

Abstract

Since the introduction of clinical pancreas transplantation as a treatment for type 1 diabetes in the United States in the 1980s, endocrinologists, save the few conducting mechanistic investigations into the consequences of restoring endocrine function on metabolism and the complications of diabetes ( 1. Morel P. Goetz F.C. Moudry-Munns K. Freier E. Sutherland D.E. Long-term glucose control in patients with pancreatic transplants. Ann Intern Med. 1991; 115: 694-699 Crossref PubMed Scopus (66) Google Scholar ), have been largely uninvolved in the evaluation for or subsequent care and monitoring of pancreas transplant recipients. Historically, this may have been appropriate, since a pancreas transplant is usually added to a kidney transplant for a type 1 diabetic patient with end-stage nephropathy. Moreover, as kidney transplantation was established first, referral to a transplant center with medical determination for the indication of adding a pancreas and monitoring its function was handled by the transplant nephrologist. Finally, because the benefits of near-normal glycemic control in type 1 diabetes were not yet appreciated, success of a pancreas transplant was measured only by the postoperative insulin requirement, with a return to insulin therapy indicating graft failure.