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. 2021 Aug;10(4):443-453.
doi: 10.21037/hbsn-19-422.

A comparative study of pancreas transplantation between type 1 and 2 diabetes mellitus

Bor-Shiuan Shyr  1 , Bor-Uei Shyr  1   2 , Shih-Chin Chen  1 , Che-Chuan Loong  2 , Yi-Ming Shyr  1 , Shin-E Wang  1
Affiliations

A comparative study of pancreas transplantation between type 1 and 2 diabetes mellitus

Bor-Shiuan Shyr et al. Hepatobiliary Surg Nutr. 2021 Aug.

Abstract

Background: Pancreas transplantation remains the best long-term treatment option to achieve physiological euglycemia and insulin independence in patients with labile diabetes mellitus (DM). It is widely accepted as an optimal procedure for type 1 DM (T1DM), but its application in type 2 DM (T2DM) is not unanimously acknowledged.

Methods: In total, 146 diabetes patients undergoing pancreas transplantation were included in this study. Clinical data and outcomes were compared between the T1DM and T2DM groups.

Results: Majority (93%) of the pancreas transplantations in T2DM were for uremic recipients. Complications occurred in 106 (73%) patients, including 70 (48%) with early complications before discharge and 79 (54%) with late complications during follow-up period. Overall, rejection of pancreas graft occurred in 37 (25%) patients. Total rejection rate in T2DM recipients was significantly lower than that in T1DM. The short- and long-term outcomes for endocrine function in terms of fasting blood sugar and hemoglobin A1c levels and graft survival rates are comparable between the T2DM and T1DM groups.

Conclusions: T2DM is not inferior to T1DM after pancreas transplantation in terms of surgical risks, immunological and endocrine outcomes, and graft survival rates. Therefore, pancreas transplantation could be an effective option to treat selected uremic T2DM patients without significant insulin resistance.

Keywords: Type 2 diabetes mellitus (T2DM); pancreas; transplantation.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/hbsn-19-422). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Serum fasting blood sugar (FBS) before pancreas transplant day 0 (PT0), pancreas transplant month 1 (PTM 1), pancreas transplant year 1 (PTY 1), pancreas transplant year 3 (PTY 3), and pancreas transplant year 5 (PTY 5). There is no significant difference regarding FBS between these type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) before and after pancreas transplant.
Figure 2
Figure 2
Serum hemoglobulin A1c (HbA1c) before pancreas transplant day 0 (PT0), pancreas transplant month 1 (PTM 1), pancreas transplant month 3 (PTM 3), pancreas transplant year 1 (PTY 1), pancreas transplant year 3 (PTY 3), and pancreas transplant year 5 (PTY 5). There is no significant difference regarding HbA1c between these type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) before and after pancreas transplant.
Figure 3
Figure 3
Serum C-peptide before pancreas transplant day 0 (PT0), pancreas transplant day 1 (PTD 1), pancreas transplant year 1 (PTY 1), pancreas transplant year 3 (PTY 3), and pancreas transplant year 5 (PTY 5). Serum C-peptide was significantly higher in type 2 diabetes mellitus (T2DM) patients before and after pancreas transplant. There was usually a high peak of serum C-peptide observed on the day 1 after pancreas transplant in both groups.
Figure 4
Figure 4
Pancreas graft survival rates after pancreas transplantation for type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). There is no significant graft survival difference between these two groups.
Figure 5
Figure 5
Patient survival rates after pancreas transplantation for type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). There is no significant patient survival difference between these two groups.
See this image and copyright information in PMC

References

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