Appropriateness and timing of kidney and/or pancreas transplants in type 1and type 2 diabetes

Cure of diabetes through cell or organ transplantation remains an unattaine d but highly desirable goal. For now, prevention of end organ complications of diabetes is the most appropriate application of transplantation for pat ients with enough evidence of progressive disease to justify the substantia l surgical and immunosuppression-based risks of pancreas transplantation. U remic diabetics should, if possible, be offered renal transplantation, alon e or in combination with pancreas transplantation, to obviate the excessive mortality associated with prolonged maintenance dialysis. Islet transplant ation has been widely clinically unsuccessful but holds new promise as the therapy of choice for the future. This report reviews the history, state of the art, and selection process for timing and application of currently ava ilable transplantation modalities for diabetic patients. (C) 2001 by the Na tional Kidney Foundation, Inc.