Pancreas and Islet Transplantation


A pancreas transplant is a surgical procedure in which a healthy pancreas from a deceased donor (cadaver) is placed in the body of a patient whose pancreas no longer functions properly.

In islet cell transplantation, pancreatic cells which produce insulin, called islets, are removed from several donor pancreata and infused into the liver of a patient with type 1 diabetes. Once transplanted, the islet cells resume the production of insulin.

Goal of transplantation:

To allow the body to once again produce its own insulin, thereby decreasing the complications of diabetes and improving the quality of life

Brief history:

Pancreas transplantation was first attempted in the mid-1960s.  However, the rates of transplant and patient survival were exceedingly low. With the development of immunosuppressive regimens (medication which prevents the body from rejecting the transplants), outcomes improved considerably.

Islet transplantation was also heavily researched in the 1960s and 70s. The first human islet transplant took place in 1990. More recently, in 2000, the “Edmonton protocol” was developed by Dr. James Shapiro and colleagues and has led to an increase in islet transplantation success.

Criteria for transplantation:

According to the American Diabetes Association, the criteria are as follows:

  1. Patients with severe kidney disease who have had or plan to have a kidney transplant are candidates for pancreas transplantation. This is the most common indication for a pancreatic transplant. Most patients receive kidney and pancreas transplants at the same time.
  1. Patients without kidney disease are candidates for pancreas transplantation if they have a history of severe and frequent complications from their diabetes including low blood sugars, very high blood sugars, and difficulty taking insulin or failure of insulin.
  2. Islet cell transplants are only given in the setting of clinical trials since they are still somewhat experimental.


    Pancreas Transplantation:

    Most patients receive a pancreas from a cadaver donor. Occasionally, patients receive half a pancreas from a living-related donor.

    Islet Transplantation:

    500,000 or more islets are isolated and removed from various (usually 2-4) cadaver pancreata and are injected into the patient’s liver.


    Pancreas Transplantation:

    Immediate post-operative complications include blood clotting, pancreatic inflammation, infection, and bleeding. Rejection, which refers to the recipient’s immune system attack of the “foreign” pancreas, can occur immediately or years later.

    Islet Transplantation:

    Patients may experience clotting or bleeding after the infusion of islet cells. As with pancreas transplantation, rejection of the donor cells is a challenge.

    Both pancreatic and islet cell transplant recipients require lifelong medications called immunosuppressants to prevent the body from rejecting the newly transplanted cells.  These medications have a host of side effects including diarrhea, low white blood cell and red blood cell counts, fatigue and high blood pressure.



    Patient survival rates after pancreas transplantation range from 95-98% at one year, 91-92% at three years and 78-88% at five years after transplant. Most of the deaths are due to heart attacks. The rate of pancreas transplant survival (defined as freedom from insulin therapy with normal blood sugar levels) is approximately 78-88% at 1 year and 54% at 10 years. The survival duration is increased by improved health of the donor pancreas.

    Studies have shown transplants lead to improvement in kidney function, nerve conduction, quality of life and possibility vision. In addition, joint kidney-pancreas transplants appear to reduce the risk of heart disease.  

    In 2009, the Collaborative Islet Transplant Registry published data showing that 70% of adults with Type 1 diabetes who underwent islet transplantation were insulin independent at 1 year, 55% at two years and only 35% at three years.

    Pancreas vs. islet transplantation:

    In various studies, patients have a higher rate of insulin independence after pancreas transplantation versus islet transplantation.

    However, the long term rate of adverse events is higher in patients who receive pancreas transplantation.

    The future of transplantation:

    Immunosuppressant regimens are continuously evolving in order to prevent side effects for recipients.

    Research is also focused on the potential use of stem cell (undifferentiated cells which have the potential to become specialized cells) to produce islets which could subsequently be used for transplantation. This would help address the current shortage of donor pancreata.

    Islet cells from pigs are being evaluated as a potential source of islet transplants.

    Islet cells may eventually be infused into the bone marrow or other places in the body rather than the liver in order to reduce complications.

    Scientists are also trying to encapsulate islet cells within thin membranes which would allow insulin to move freely but would not allow the recipient’s antibodies to cross, thereby preventing rejection. 

    Collaborative Islet Transplant Registry.

    Kahn MH et al. Counterpoint:clinical islet transplantation: not ready for prime time. Diabetes Care 2009; 32:1570.

    Kelly WD et al. Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy. Surgery. 1967; 61 (6):827.

    Maffi P et al. Risks and benefits of transplantation in the cure of type 1 diabetes: whole pancreas versus islet transplantation. A single center study. Rev Diabet Stud. 2011; 81 (1) 44.

    Robertson RP et al. Pancreas and islet transplantation in type 1 diabetes. Diabetes Care 2006; 29:935.

    Sutherland DE. Lessons learned from more than 1,000 pancreas transplants at a single institution. Ann Surg. 2001; 233(4):463.

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