Transplantation for type I diabetes: comparison of vascularized whole-organ pancreas with isolated pancreatic islets.

Authors

• Adam Frank
• Shaoping Deng
• Xiaolun Huang
• Ergun Velidedeoglu
• Yong-Suk Bae
• Chengyang Liu
• Peter Abt
• Robert Stephenson
• Muhammad Mohiuddin
• Thav Thambipillai
• Eileen Markmann
• Maral Palanjian
• Marty Sellers
• Ali Naji
• Clyde F Barker
• James F Markmann

Publication/Presentation Date

10-1-2004

Abstract

OBJECTIVE: We sought to compare the efficacy, risks, and costs of whole-organ pancreas transplantation (WOP) with the costs of isolated islet transplantation (IIT) in the treatment of patients with type I diabetes mellitus.

SUMMARY BACKGROUND DATA: A striking improvement has taken place in the results of IIT with regard to attaining normoglycemia and insulin independence of type I diabetic recipients. Theoretically, this minimally invasive therapy should replace WOP because its risks and expense should be less. To date, however, no systematic comparisons of these 2 options have been reported.

METHODS: We conducted a retrospective analysis of a consecutive series of WOP and IIT performed at the University of Pennsylvania between September 2001 and February 2004. We compared a variety of parameters, including patient and graft survival, degree and duration of glucose homeostasis, procedural and immunosuppressive complications, and resources utilization.

RESULTS: Both WOP and IIT proved highly successful at establishing insulin independence in type I diabetic patients. Whole-organ pancreas recipients experienced longer lengths of stay, more readmissions, and more complications, but they exhibited a more durable state of normoglycemia with greater insulin reserves. Achieving insulin independence by IIT proved surprisingly more expensive, despite shorter initial hospital and readmission stays.

CONCLUSION: Despite recent improvement in the success of IIT, WOP provides a more reliable and durable restoration of normoglycemia. Although IIT was associated with less procedure-related morbidity and shorter hospital stays, we unexpectedly found IIT to be more costly than WOP. This was largely due to IIT requiring islets from multiple donors to gain insulin independence. Because donor pancreata that are unsuitable for WOP can often be used successfully for IIT, we suggest that as IIT evolves, it should continue to be evaluated as a complementary alternative to rather than as a replacement for the better-established method of WOP.

Volume

240

Issue

4

First Page

631

Last Page

640

ISSN

0003-4932

Published In/Presented At

Frank, A., Deng, S., Huang, X., Velidedeoglu, E., Bae, Y. S., Liu, C., Abt, P., Stephenson, R., Mohiuddin, M., Thambipillai, T., Markmann, E., Palanjian, M., Sellers, M., Naji, A., Barker, C. F., & Markmann, J. F. (2004). Transplantation for type I diabetes: comparison of vascularized whole-organ pancreas with isolated pancreatic islets. Annals of surgery, 240(4), 631–643. https://doi.org/10.1097/01.sla.0000140754.26575.2a

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

15383791

Department(s)

Administration and Leadership

Document Type

Article