Development of diabetes mellitus in living pancreas donors and recipients

Abstract

Previously, recurrence of insulin-dependent diabetes mellitus after pancreas transplants was only sporadically reported. Newer data, however, indicate recurrence rates as high as 5%. After identical-twin pancreas transplants, diabetes recurs in the absence of immunosuppressive therapy – strong evidence that it is an autoimmune disease. After deceased donor pancreas transplants, immunologic markers (autoantibodies, autoreactive T cells) herald recurrence. Selective destruction of β cells, still relatively uncommon, is not restricted to MHC compatibility. The development of diabetes in living pancreas donors is rare; it can be largely avoided by meticulous metabolic evaluation before donation and prevention of obesity after donation.

Keywords::

• diabetes mellitus
• GAD-65
• IA-2
• islet cells
• living donor
• pancreas transplant
• post-transplant recurrence
• twin

Financial & competing interests disclosure

Collaborative studies performed by the University of Miami and Benaroya Research Institute were supported by research grants from the National Institutes of Health (5RO1-DK-070011 and AI-50864), the American Diabetes Association (1-09-RA-413, 1-05-RA-105), the Juvenile Diabetes Research Foundation (JDRF 1-2005-257), and the Diabetes Research Institute Foundation, Hollywood, FL, USA. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.