Expansion of the Pancreas Transplant Recipient Pool: Appropriate for Most or Are There Limits?

Pancreas transplantation is currently the only available therapy capable of reliably reestablishing normal glucose homeostasis independent of exogenous insulin in patients with diabetes. Historically, this procedure was reserved exclusively for suitable candidates with Type 1 diabetes mellitus (T1DM).

Indications for pancreas transplantation have been liberalized to include patients with T1DM that were previously not considered suitable, select candidates with Type 2 DM, and rarely for less common forms of diabetes.

This review examines standard indications and contraindications for pancreas transplantation including expansion of criteria for candidates who are older, have obesity, or are medically or surgically complex. It remains unclear whether pancreas transplant is appropriate for most candidates with diabetes, particularly those with uremia, irrespective of age, size, diabetes type, or insulin need/dose, or if it remains appropriate only for a select group of patients.