Pancreas Transplantation: Current Challenges, Considerations, and Controversies

Area of Science:

• Transplantation immunology
• Endocrinology
• Nephrology

Background:

• Pancreas transplantation (PTx) offers a functional, autoregulating source of endogenous insulin.
• Successful PTx eliminates the need for exogenous insulin, normalizes glucose homeostasis, and improves quality of life for patients with diabetes.
• Despite improved outcomes and expanded criteria, PTx activity has decreased in the 21st century.

Purpose of the Study:

• To highlight the benefits of pancreas transplantation in managing complex diabetes.
• To address the decline in PTx activity and advocate for its broader consideration.
• To emphasize the importance of PTx for patients with insulin-dependent diabetes failing conventional therapy.

Main Methods:

• Review of existing literature and clinical experience with pancreas transplantation.
• Analysis of factors contributing to the decline in PTx rates.
• Discussion of current challenges and recommendations for improving PTx access and integration into diabetes care.

Main Results:

• PTx provides complete beta-cell replacement, mitigating glycemic variability and restoring normal glucose homeostasis.
• Key barriers to PTx include lack of primary referral, absence of consensus criteria, and resource limitations.
• Patients often face challenges navigating the conventional diabetes care model to access transplant options.

Conclusions:

• Pancreas transplantation should be more prominently featured in management algorithms for patients with insulin-requiring diabetes experiencing complications or failing therapy.
• Simultaneous pancreas-kidney transplantation should be considered for all patients with diabetes and chronic kidney disease.
• Addressing access, education, and community acceptance is crucial for revitalizing PTx activity.