Diabetic nephropathy and beta-cell replacement therapy

Whole pancreas transplantation can effectively restore endogenous insulin secretion in type 1 diabetes mellitus, and prevent, retard, or reverse diabetic complications. The effect of a simultaneous pancreas and kidney transplantation (SPKT) on diabetic complications is variable. These reports must be interpreted in the light of the fact that most recipients received a pancreas in combination with a kidney graft after having already had diabetes for over two decades. Nevertheless, the potential benefits should also be balanced against the risk of peroperative morbidity and the requirement of long-term immunosuppressive medication. Transplantation of a whole pancreas is currently the only reliable option to achieve long-term normoglycaemia. The success of pancreatic islets transplantation will ultimately depend on the longevity of pancreatic islets, requiring further development of immunosuppressive regimens which are not toxic to the islets and prevent recurrent autoimmune destruction of transplanted pancreatic beta-cells.