Review
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplantation. Nov 30, 2018; 8(7): 237-251
Published online Nov 30, 2018. doi: 10.5500/wjt.v8.i7.237
Solid pancreas transplant: Pushing forward
Emmanouil Giorgakis, Amit K Mathur, Harini A Chakkera, Kunam S Reddy, Adyr A Moss, Andrew L Singer
Emmanouil Giorgakis, Amit K Mathur, Kunam S Reddy, Adyr A Moss, Andrew L Singer, Division of Transplant, Department of Surgery, Mayo Clinic, Phoenix, AZ 85054, United States
Emmanouil Giorgakis, Department of Transplant, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
Harini A Chakkera, Division of Nephrology, Department of Internal Medicine, Mayo Clinic, Phoenix, AZ 85054, United States
Author contributions: Giorgakis E designed the study, performed data collection, and wrote the manuscript; Chakkera HA, Reddy KS, and Moss AA reviewed and edited the manuscript; Mathur AK and Singer AL contributed to conceptualization, study design, editing and final approval of the manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Emmanouil Giorgakis, MD, MSc, Surgeon, Assistant Professor of Surgery, Department of Transplant, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205, United States. egiorgakis@uams.edu
Telephone: +1-501-5266380
Received: June 9, 2018
Peer-review started: June 9, 2018
First decision: July 12, 2018
Revised: November 10, 2018
Accepted: November 15, 2018
Article in press: November 15, 2018
Published online: November 30, 2018
Abstract

Pancreas transplant has evolved significantly in recent years. It has now become a viable treatment option on type 1 diabetic patients with poorly controlled diabetes on conventional treatment, insulin intolerance, hypoglycaemia unawareness, brittle diabetes and/ or end-stage kidney disease. The purpose of this review is to provide an overview of pancreas transplant historical origins and current barriers to broader utilization of pancreata for transplant, with a focus on areas for future improvement to better pancreas transplant care. Donor pancreata remain underutilized; pancreatic allograft discard rates remain close to 30% in the United States. Donations after cardiac death (DCD) pancreata are seldom procured. Study groups from Europe and the United Kingdom showed that procurement professionalization and standardization of technique, as well as development of independent regional procurement teams might increase organ procurement efficiency, decrease discards and increase pancreatic allograft utilization. Pancreas transplant programs should consider exploring pancreas procurement opportunities on DCD and obese donors. Selected type 2 diabetics should be considered for pancreas transplant. Longer follow-up studies need to be performed in order to ascertain the long-term cardiovascular and quality of life benefits following pancreas transplant; the outcomes of which might eventually spearhead advocacy towards broader application of pancreas transplant among diabetics.

Keywords: Pancreas transplant, Whole pancreas transplant, Donations after cardiac death pancreas transplant, Obese pancreas donors, Pancreas transplant for type 2 diabetes

Core tip: Pancreas transplant has become a viable treatment option on type 1 diabetics. The purpose of this review is to describe current barriers to broader pancreatic allograft utilization, and focus on areas for future improvement. Donor pancreata, especially Donations after cardiac death (DCD), remain underutilized. Procurement professionalization might decrease discards and increase pancreatic allograft utilization. Pancreas procurements should be extended to DCDs and suitable obese donors. C-peptide positive non-obese brittle diabetics may be suitable transplant candidates. Longer studies on pancreas transplant cardiovascular benefits are needed; this might eventually drive pancreas transplant advocacy among diabetics.