Pancreas and Islet Allograft Failure

The treatment of diabetes mellitus is aimed at improving glycemic control. Establishing relatively tight control using exogenous insulin has been shown to reduce the ophthal-mologic, neurologic and renal complications of diabetes mellitus.1 However, achieving a glycosylated hemoglobin (Hgb A1C) level low enough to reduce secondary complications (a level of approximately 7.0%) is associated with an increased risk of severe, life-threatening hypoglycemia. Both whole organ pancreas transplantation and isolated islet transplantation offer the possibility of even better glycemic control (average Hgb A1C < 6.0%) with the addition of counter-regulatory feedback hormones that avoid life-threatening hypoglycemia.