Pancreas/islet-kidney transplantation for type 2 diabetes mellitus
Yong-Feng Liu

Pancreas/islet-kidney transplant has gained acceptance as an effective treatment option for patients with diabetes mellitus (DM) and end stage renal disease from diabetic nephropathy (DN). After successful transplants, patients become normaglycemic with complete freedom of insulin therapy and experience improvement in quality of life. In additions, pancreas transplant has ameliorating effect on chronic diabetic complications for long term maintenance of tight glycemic control. Before mid-20th century, type 2 DM was considered as a contraindication for pancreas replacement. However, since then, the overall rate of patients categorized as type 2 diabetics increased from 2% in 1995 to 7% in 2010. In our center, 26 cases of simultaneous pancreas-kidney transplantation were performed since September 1999, including 19 patients of type 2 DM. All the type 2 patients used insulin and suffered from renal failure and other chronic complications. For type 2 DM patients, insulin was withdrawn in 5-9 days. Kidney function recovered in 2-4 days after operation for all the patients. All grafts survived except one type 2 DM patient died at one month due to infection but with functioning pancreas and kidney. In conclusion, our small retrospective study suggests that pancreas transplants can provide good long-term glucose control in recipients with type 2 DM.

Large yields of highly active islets are essential for a successful transplantation. In 1988 Ricordi and colleagues invented an automated pancreatic digestive device, which was used successfully for islet transplantation by members of the Shapiro lab (Edmonton, Canada) in 2000. The use of the Ricordi automated device for separation and the COBE-2991 cell processor for purification has significantly improved the efficiency of islet isolation and stimulated the development of islet transplantation. Four cases of islet-kidney transplant were performed for 3 patients of type 2 DM (one patient received two transplants) in our hospital since 2007. One patient died from bleeding. One patient gained insulin decreased to half, and the other one who received two transplant gained insulin-free.