Pancreas Versus Islets After a Successful Kidney Transplant

Boris L. Gala-Lopez; Andrew R. Pepper; A. M.James Shapiro

doi:10.1007/s40472-014-0016-7

Pancreas Versus Islets After a Successful Kidney Transplant

Boris L. Gala-Lopez, Andrew R. Pepper, A. M.James Shapiro

Producción científica: Contribución a una revista › Artículo › revisión exhaustiva

2 Citas (Scopus)

Resumen

The optimal endocrine transplant that should follow a successful kidney transplant in patients with type 1 diabetes is currently open to debate. Ideally, a combined kidney and pancreas transplant is carried out simultaneously from an optimal donor as there is clear immunological benefit. However, when a living donor kidney transplant occurs initially, either a pancreas after kidney or islet after kidney transplant may be considered. A pancreas after kidney transplant carries more surgical risk but provides more robust endocrine reserve compared to the alternative option of islet after kidney transplantation. Furthermore, islet transplantation is not universally available, requires specialized manufacturing facilities, and the costs associated with islet manufacture may not be reimbursable by healthcare. From a patient’s perspective, however, islet after kidney transplantation is a highly attractive option to avoid further surgical risk and recovery. This paper discusses the merits and demerits of these alternative transplant options, and debates both competitive aspects and complementarity. We discuss current outcomes and ongoing clinical trials.

Idioma original	English
Páginas (desde-hasta)	124-135
Número de páginas	12
Publicación	Current Transplantation Reports
Volumen	1
N.º	2
DOI	https://doi.org/10.1007/s40472-014-0016-7
Estado	Published - jun. 1 2014
Publicado de forma externa	Sí

Nota bibliográfica

Funding Information:
Boris L. Gala-Lopez is supported through the Izaak Walton Killam Scholarship, and through a scholarship from the Alberta Diabetes Institute/University of Alberta. Andrew R. Pepper received a MITACS government of Canada-Industry-Academic partnership grant. A. M. James Shapiro is supported through Alberta Innovates Healthcare Solutions, and holds a Canada Research Chair in Transplantation Surgery and Regenerative Medicine funded through the Government of Canada. The clinical islet transplant program is supported through Alberta Healthcare, and receives research support through the Collaborative Islet Transplant Consortium (CIT) funded through the National Institutes of Health (NIH), National Institute of Digestive Diseases and Kidney (NIDDK) and through the National Institute of Allergy and Infectious Diseases (NIAID). The islet program also receives funding through the Juvenile Diabetes Research Foundation (JDRF), and through the Diabetes Research Institute Foundation of Canada (DRIFCan). All authors are also supported by AIHS CRIO Team Award #201201154.

Funding Information:
Boris L. Gala-Lopez is supported through the Izaak Walton Killam Scholarship, and through a scholarship from the Alberta Diabetes Institute/University of Alberta. Andrew R. Pepper received a MITACS government of Canada-Industry-Academic partnership grant. A. M. James Shapiro is supported through Alberta Innovates Healthcare Solutions, and holds a Canada Research Chair in Transplantation Surgery and Regenerative Medicine funded through the Government of Canada. The clinical islet transplant program is supported through Alberta Healthcare, and receives research support through the Collaborative Islet Transplant Consortium (CIT) funded through the National Institutes of Health (NIH), National Institute of Digestive Diseases and Kidney (NIDDK) and through the National Institute of Allergy and Infectious Diseases (NIAID). The islet program also receives funding through the Juvenile Diabetes Research Foundation (JDRF), and through the Diabetes Research Institute Foundation of Canada (DRIFCan). All authors are also supported by AIHS CRIO Team Award #201201154. The authors thank the International Pancreas Transplant Registry for providing access to data published on their 2010 Annual report, as well as the Collaborative Islet Transplant Registry for granting access to their Seventh Annual Report. The data reported in the 2011 Annual Data Report of the Organ Procurement and Transplantation Network and the US Scientific Registry of Transplant Recipients was kindly provided by the Minneapolis Medical Research Foundation and UNOS under contract with HHS/HRSA. The authors alone are responsible for reporting and interpreting these data, and the views expressed herein. ? Boris L. Gala-Lopez, Andrew R. Pepper, and A. M. James Shapiro declare that they have no conflict of interest. This article does not contain any studies with human or animal subjects performed by any of the authors.

Funding Information:
The data reported in the 2011 Annual Data Report of the Organ Procurement and Transplantation Network and the US Scientific Registry of Transplant Recipients was kindly provided by the Minneapolis Medical Research Foundation and UNOS under contract with HHS/HRSA. The authors alone are responsible for reporting and interpreting these data, and the views expressed herein.

Publisher Copyright:
© 2014, Springer International Publishing AG.

ASJC Scopus Subject Areas

Transplantation
Surgery
Hepatology
Nephrology
Immunology

ODS de las Naciones Unidas

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title = "Pancreas Versus Islets After a Successful Kidney Transplant",

abstract = "The optimal endocrine transplant that should follow a successful kidney transplant in patients with type 1 diabetes is currently open to debate. Ideally, a combined kidney and pancreas transplant is carried out simultaneously from an optimal donor as there is clear immunological benefit. However, when a living donor kidney transplant occurs initially, either a pancreas after kidney or islet after kidney transplant may be considered. A pancreas after kidney transplant carries more surgical risk but provides more robust endocrine reserve compared to the alternative option of islet after kidney transplantation. Furthermore, islet transplantation is not universally available, requires specialized manufacturing facilities, and the costs associated with islet manufacture may not be reimbursable by healthcare. From a patient{\textquoteright}s perspective, however, islet after kidney transplantation is a highly attractive option to avoid further surgical risk and recovery. This paper discusses the merits and demerits of these alternative transplant options, and debates both competitive aspects and complementarity. We discuss current outcomes and ongoing clinical trials.",

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Pancreas Versus Islets After a Successful Kidney Transplant

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