Chapter 34 - Islet vs pancreas transplantation in nonuremic patients with type 1 diabetes

Abstract

Type 1 diabetes represents a significant health-care burden. Both islet and solid organ pancreas transplantation are now established techniques of β-cell replacement therapy to achieve insulin independence. While solid organ transplantation is the current standard, islet transplantation remains a promising option. It offers to establish normoglycemia, protects against hypoglycemia and glycemic lability, and is associated with fewer risks than solid organ pancreas transplant. Islet transplantation is a viable alternative under specific clinical circumstances. Improving success for islet transplantation in terms of insulin independence suggest an important role for islet transplantation if patients are deemed unsuitable for solid organ pancreas transplantation. Although immunosuppression protocols have improved islet transplant outcomes, further work is necessary to optimize the availability of islets for transplant and to improve islet viability once transplanted.