Pancreas vs. Islet Transplantation: the False Dilemma

Purpose of Review Pancreas and islet cell transplantation are the only treatment modalities that can restore euglycemia and allow freedom from hypoglycemic events. Transplantation for diabetes has decreased in the USA over the last 6 years due to several factors. Reasons for this and possible future paths will be explored. Recent Findings Clinical application of islet transplantation is mostly limited by regulatory hurdles in the USA. The limitations of pancreas transplantation are multifactorial and more nuanced. Both types of transplants are limited by the number of suitable organ donors; however, pancreas and islet transplantation do not compete for the same organs. Only 10.7% of available pancreata are currently being utilized for clinical application. Current technology if utilized more efficiently could significantly increase the available donor pancreata for both whole organ and islets. Considering that severely diseased pancreata are routinely processed for islets and subsequent transplanted in chronic pancreatitis patients, and have significant metabolic impact in these patients, there is an opportunity to widen the organ use beyond what is currently done. Optimizing access to beta-cell replacement therapy has significant potential to improve outcomes for carefully selected patients.