In this panel discussion, physicians presented the benefits of pancreas transplants for people with type 1 diabetes and the barriers to this type of therapy.
The doctors noted that the procedure is done in conjunction with a kidney transplant, and that success rates have improved a great deal in recent years with the introduction of cyclosporine and other immunosuppressive drugs. Patient survival is now approximately four times greater than when the procedure was first being done.
Patients who receive successful transplants experience drastically improved HbA1cs and improved glucagon levels. Symptoms of gastroparesis are also greatly improved. The same is true with motor and sensory nerve function, but they never reach nondiabetic levels.
No beneficial effect on retinopathy is observed. The presenters note that this lack of effect is likely due to the fact that most transplant recipients have had relatively poorly controlled diabetes for 15 to 20 years or more, so most of the retinal damage has already been done.
The presenters claimed that transplantation should be an available option for type 1s who suffer from very brittle diabetes, in addition to those with end stage renal disease. They note that it is often a quality of life issue and feel that it should be available to people with profoundly problematic diabetes control.
Every presenter noted that there has never been a randomized clinical trial on the effectiveness of pancreas transplantation. As a result, it is difficult, if not impossible, to convince medical care payers that transplantations are an efficient use of their money.
“We have to be able to come up with something better than personal opinion and case histories. If not, it (pancreas transplant availability) will be decided by people interested in budgets rather than by doctors,” says presenter, Thomas Holohan, MD.