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Updated: May 25, 2026
Transplantation of Pancreatic Islets Into the Kidney Capsule of Diabetic Mice
Published on: October 31, 2007
Reversal of diabetic nephropathy: lessons from pancreas transplantation
Paola Fioretto1, Michael Mauer
1Department of Medicine, University of Padova Medical School, Padova, Italy. paola.fioretto@unipd.it
Abstract:
Pancreas transplantation is the only therapeutic intervention able to achieve and maintain long-term euglycemia, without risks of hypoglycemia; this makes it possible to test the impact of normoglycemia in the different stages of diabetic nephropathy. Pancreas and islet transplantation in animal models prevent the development of diabetic nephropathy lesions and ameliorate or reverse established glomerular lesions. In type 1 diabetic patients, pancreas transplantation, performed simultaneously or after kidney transplantation, has been shown to prevent the recurrence of diabetic glomerulopathy lesions. The established lesions of diabetic nephropathy have been considered to be irreversible; pancreas transplantation alone allows us to test whether this is true. To this end, we studied renal structure before and 5 and 10 years after pancreas transplantation in 8 nonuremic type 1 diabetic patients. These patients, with a long diabetes duration, had established diabetic nephropathy lesions at the time of transplantation. We report that diabetic glomerulopathy lesions, unchanged at 5 years post pancreas transplantation, significantly improved after 10 years, with complete normalization of glomerular structure in most patients. Thus this study demonstrates that the lesions of diabetic nephropathy are reversed by long-term normoglycemia and that the human kidney has the potential in humans to obtain a substantial architectural remodeling of the glomerular and tubular structures toward healing.
Insights
Pancreas transplantation can reverse diabetic nephropathy. Long-term normoglycemia achieved through pancreas transplantation significantly improved kidney structure, demonstrating healing potential in diabetic patients.
Area of Science:
- Nephrology
- Endocrinology
- Transplantation Immunology
Background:
- Diabetic nephropathy is a leading cause of kidney failure.
- Established diabetic nephropathy lesions were previously considered irreversible.
- Pancreas transplantation offers sustained normoglycemia, a potential treatment for diabetic complications.
Purpose of the Study:
- To investigate the reversibility of established diabetic nephropathy lesions.
- To assess the long-term impact of pancreas transplantation on renal structure in type 1 diabetic patients.
- To determine if normoglycemia can induce healing and architectural remodeling in the human kidney.
Main Methods:
- Studied renal structure in 8 nonuremic type 1 diabetic patients before and 5, 10 years after pancreas transplantation.
- Patients had established diabetic nephropathy at baseline.
- Evaluated glomerular and tubular structures for changes over time.
Main Results:
- Diabetic glomerulopathy lesions remained unchanged at 5 years post-transplantation.
- Significant improvement in glomerular structure was observed at 10 years.
- Complete normalization of glomerular structure occurred in most patients, indicating substantial healing.
Conclusions:
- Long-term normoglycemia achieved via pancreas transplantation can reverse established diabetic nephropathy lesions.
- The human kidney possesses a remarkable capacity for architectural remodeling and healing in response to sustained normal glucose levels.
- Pancreas transplantation is a viable therapeutic strategy for addressing advanced diabetic kidney disease.
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01:26Kidney Transplant II: Surgical Procedure
01:29Chronic Pancreatitis II: Collaborative Care
Assessment:
01:16Kidney Transplant III: Nursing Management