When to Refer a Diabetic Patient for Pancreas Transplantation

Why Pancreas Transplantation?

The goal of pancreas transplantation is to replace insulin-producing cells in order to control blood glucose levels continuously for the individual. In doing so, this is essentially a cure for diabetes. Frequently, patients are rendered insulin-free or require a much lower dose of insulin to maintain stable blood glucose levels. In this environment, the effects of diabetes mellitus will not progress. For example, kidney disease due to diabetes improves, nerve disease will remain stable or improve, and vascular disease remains stable.

Pancreas Transplantation Options

Pancreas transplantation options include:

  • Simultaneous Pancreas Kidney (SPK)
  • Pancreas After Kidney (PAK)
  • Pancreas Transplant Alone (PTA)
  • Islet Cell

Who is Eligible For a Pancreas Transplant?

Patients ages 18 to 55 with a body mass index less than 32 must meet the following criteria to be considered for pancreas transplantation. A complete medical/surgical, cardiac, vascular and psychosocial evaluation will be performed to determine candidacy.

Criteria for Pancreas Transplant by Transplant Type

  SPK1
Transplant
PAK2
Transplant
PTA3
Transplant
Diabetes Type I or
Type II
Type I or
Type II
Type I
only
Glomerular filtration rate
(milliliters/minute/1.73 m2)
<20 >40 >60
C-peptide <10 <10 Non-detectable
Hemoglobin A1c (if type II) <7 <7 Not Applicable
Insulin requirement
(if type II)
<1U/kg/day <1U/kg/day Not Applicable

1SPK: Simultaneous kidney and pancreas transplantation: In this situation, individuals have developed end-stage renal disease due to diabetes. Additionally, other problems stemming from diabetes may have also occurred by now. Patients in this situation can be evaluated for a kidney and pancreas transplant performed simultaneously. Those waiting for both organs usually experience a shorter waiting time for their transplant than those listed for kidney transplant alone.

2PAK: Pancreas after kidney transplantation: Patients with diabetes mellitus who have had a kidney transplant performed for end-stage renal disease can potentially be a suitable candidate to receive a pancreas transplant. In this situation, other problems stemming from diabetes are also present. Also, the pancreas transplant can offer some protection to the kidney transplant from the effects of diabetes and possible failure of the kidney transplant due to diabetes.

3PTA: Pancreas transplantation alone: Patients with diabetes mellitus who have good kidney function but have severe difficulty in controlling their blood glucose levels and who potentially experience hypoglycemic unawareness are eligible for this type of transplantation.

Islet cell transplantation: In this situation, only the insulin-producing cells of the pancreas are given to the patient. Patients must have good kidney function, they must experience hypoglycemic unawareness on a frequent basis, and have a low body mass index. Currently, University Hospitals Transplant Institute does not perform this type of transplantation but will screen potential candidates and direct them to a center that performs this type of transplantation.

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