The impact of pancreas transplantation on secondary complications of diabetes

Purpose of review: This review examines recent literature on the difficulties in obtaining definitive answers regarding the progression of complications following pancreas transplantation. Recent findings: Pancreas transplantation techniques, and their metabolic results, have steadily improved in the past two decades. Patients seeking pancreas transplantation are concerned about the impact of chronic diabetes and its secondary complications, and many have undergone the procedure without knowing whether transplantation would affect the progression of their disease. Yet, although the procedure has been performed for several decades, not all questions regarding the impact of pancreas transplantation on diabetic complications can be answered. Summary: Overall, patients report improvements in their quality of life after pancreas transplantation, and evidence exists for resultant protection from nephropathy, regression of sensory-motor neuropathy and improvements in cardiac function and microangiopathy. Autonomic neuropathies and retinopathies also appear to improve after prolonged observation. With the advent of nonnephrotoxic immune suppression, appropriate prospective, randomized controlled trials can be done in patients with type 1 diabetes who are not in renal failure, to decisively answer questions related to secondary complications following pancreas transplantation. These studies should include patients treated with insulin therapy as controls.