Pancreas vs. Islet Transplantation: the False Dilemma

Cryer PE. Glycemic goals in diabetes: trade-off between glycemic control and iatrogenic hypoglycemia. Diabetes. 2014;63(7):2188–95. Kelly WD, Lillehei RC, Merkel FK, Idezuki Y, Goetz FC. Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy. Surgery. 1967;61(6):827–37. Sutherland DE, Gruessner RW, Dunn DL, Matas AJ, Humar A, Kandaswamy R, et al. Lessons learned from more than 1,000 pancreas transplants at a single institution. Ann Surg. 2001;233(4):463–501. Najarian JS, Sutherland DE, Matas AJ, Steffes MW, Simmons RL, Goetz FC. Human islet transplantation: a preliminary report. Transplant Proc. 1977;9(1):233–6. •• Shapiro AM, Lakey JR, Ryan EA, Korbutt GS, Toth E, Warnock GL, et al. Islet transplantation in seven patients with type 1 diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. N Engl J Med. 2000;343(4):230–8 Key publication demonstrating consistent reversal of diabetes using allogeneic islets. Ricordi C, Lacy PE, Finke EH, Olack BJ, Scharp DW. Automated method for isolation of human pancreatic islets. Diabetes. 1988;37(4):413–20. Bretzel RG, Hering BJ, Federlin KF. Islet cell transplantation in diabetes mellitus--from bench to bedside. Exp Clin Endocrinol Diabetes. 1995;103(Suppl 2):143–59. Kandaswamy R, Stock PG, Gustafson SK, Skeans MA, Urban R, Fox A, et al. OPTN/SRTR 2018 Annual Data Report: Pancreas. Am J Transplant. 2020;20 Suppl s1:131–92. Gruessner AC, Gruessner RWG. Pancreas transplantation for patients with type 1 and type 2 diabetes mellitus in the United States: a registry report. Gastroenterol Clin N Am. 2018;47(2):417–41. Israni AK, Zaun D, Hadley N, Rosendale JD, Schaffhausen C, McKinney W, et al. OPTN/SRTR 2018 annual data report: deceased organ donation. Am J Transplant. 2020;20 Suppl s1:509–41. Oyer DS. The science of hypoglycemia in patients with diabetes. Curr Diabetes Rev. 2013;9(3):195–208. Cryer PE. Hypoglycemia-associated autonomic failure in diabetes. Handb Clin Neurol. 2013;117:295–307. • Stratta RJ, Gruessner AC, Odorico JS, Fridell JA, Gruessner RW. Pancreas transplantation: an alarming crisis in confidence. Am J Transplant. 2016;16(9):2556–62 Good overview of limitations and possible correction of current pancreas transplant utilization rates. Humar A, Ramcharan T, Kandaswamy R, Gruessner RW, Gruessner AC, Sutherland DE. Technical failures after pancreas transplants: why grafts fail and the risk factors--a multivariate analysis. Transplantation. 2004;78(8):1188–92. Finger EB, Radosevich DM, Dunn TB, Chinnakotla S, Sutherland DE, Matas AJ, et al. A composite risk model for predicting technical failure in pancreas transplantation. Am J Transplant. 2013;13(7):1840–9. Hilling DE, Baranski AG, Haasnoot A, van der Boog PJ, Terpstra OT, Marang-van de Mheen PJ. Contribution of donor and recipient characteristics to short- and long-term pancreas graft survival. Ann Transplant. 2012;17(4):28–38. Axelrod DA, Sung RS, Meyer KH, Wolfe RA, Kaufman DB. Systematic evaluation of pancreas allograft quality, outcomes and geographic variation in utilization. Am J Transplant. 2010;10(4):837–45. Krieger NR, Odorico JS, Heisey DM, D'Alessandro AM, Knechtle SJ, Pirsch JD, et al. Underutilization of pancreas donors. Transplantation. 2003;75(8):1271–6. Salvalaggio PR, Davies DB, Fernandez LA, Kaufman DB. Outcomes of pancreas transplantation in the United States using cardiac-death donors. Am J Transplant. 2006;6(5 Pt 1):1059–65. Hering BJ, Kandaswamy R, Ansite JD, Eckman PM, Nakano M, Sawada T, et al. Single-donor, marginal-dose islet transplantation in patients with type 1 diabetes. JAMA. 2005;293(7):830–5. • Bellin MD, Barton FB, Heitman A, Harmon JV, Kandaswamy R, Balamurugan AN, et al. Potent induction immunotherapy promotes long-term insulin independence after islet transplantation in type 1 diabetes. Am J Transplant. 2012;12(6):1576–83 Important observation that islet transplantation can achieve similar metabolic outcomes as whole-organ pancreas transplantation. Saravanan PB, Kanak MA, Chang CA, Darden C, Yoshimatsu G, Lawrence MC, et al. Islet damage during isolation as assessed by miRNAs and the correlation of miRNA levels with posttransplantation outcome in islet autotransplantation. Am J Transplant. 2018;18(4):982–9. Naziruddin B, Iwahashi S, Kanak MA, Takita M, Itoh T, Levy MF. Evidence for instant blood-mediated inflammatory reaction in clinical autologous islet transplantation. Am J Transplant. 2014;14(2):428–37. Ricordi C, Goldstein JS, Balamurugan AN, Szot GL, Kin T, Liu C, et al. National Institutes of Health-sponsored Clinical Islet Transplantation Consortium phase 3 trial: manufacture of a complex cellular product at eight processing facilities. Diabetes. 2016;65(11):3418–28. Niclauss N, Bosco D, Morel P, Demuylder-Mischler S, Brault C, Milliat-Guittard L, et al. Influence of donor age on islet isolation and transplantation outcome. Transplantation. 2011;91(3):360–6. Wang LJ, Kin T, O'Gorman D, Shapiro AMJ, Naziruddin B, Takita M, et al. A multicenter study: North American islet donor score in donor pancreas selection for human islet isolation for transplantation. Cell Transplant. 2016;25(8):1515–23. Balamurugan AN, Naziruddin B, Lockridge A, Tiwari M, Loganathan G, Takita M, et al. Islet product characteristics and factors related to successful human islet transplantation from the Collaborative Islet Transplant Registry (CITR) 1999-2010. Am J Transplant. 2014;14(11):2595–606. • Shapiro AMJ. Islet transplantation - the Canadian perspective. CellR4 Repair Replace Regen Reprogram. 2019;7:e2799 Current overview from the most impactful islet transplant center. Hering BJ, Clarke WR, Bridges ND, Eggerman TL, Alejandro R, Bellin MD, et al. Phase 3 trial of transplantation of human islets in type 1 diabetes complicated by severe hypoglycemia. Diabetes Care. 2016;39(7):1230–40. Saito T, Gotoh M, Satomi S, Uemoto S, Kenmochi T, Itoh T, et al. Islet transplantation using donors after cardiac death: report of the Japan Islet Transplantation Registry. Transplantation. 2010;90(7):740–7. Ricordi C, Fraker C, Szust J, Al-Abdullah I, Poggioli R, Kirlew T, et al. Improved human islet isolation outcome from marginal donors following addition of oxygenated perfluorocarbon to the cold-storage solution. Transplantation. 2003;75(9):1524–7. Sutherland DE, Gruessner AC, Carlson AM, Blondet JJ, Balamurugan AN, Reigstad KF, et al. Islet autotransplant outcomes after total pancreatectomy: a contrast to islet allograft outcomes. Transplantation. 2008;86(12):1799–802. Sutherland DE, Radosevich DM, Bellin MD, Hering BJ, Beilman GJ, Dunn TB, et al. Total pancreatectomy and islet autotransplantation for chronic pancreatitis. J Am Coll Surg. 2012;214(4):409–24 discussion 24-6. Ris F, Toso C, Veith FU, Majno P, Morel P, Oberholzer J. Are criteria for islet and pancreas donors sufficiently different to minimize competition? Am J Transplant. 2004;4(5):763–6. Kandaswamy R, Sutherland DE. Pancreas versus islet transplantation in diabetes mellitus: how to allocate deceased donor pancreata? Transplant Proc. 2006;38(2):365–7. Berney T, Johnson PR. Donor pancreata: evolving approaches to organ allocation for whole pancreas versus islet transplantation. Transplantation. 2010;90(3):238–43.