Diabetics who stick with insulin injections and blood-sugar monitoring have better odds of survival than those who opt for a disease-curing pancreas transplant, a drastic but increasingly common option, a study suggests.
Diabetes occurs when the body cannot produce or properly use insulin, a blood sugar-regulating hormone produced in the pancreas. A pancreas transplant can essentially cure diabetes.
Patients who received pancreas-only transplants had a one-year survival rate of 97 percent and a four-year rate of 85 percent, compared with 98 percent and 92 percent of those who tried to control their diabetes by conventional means while awaiting a transplant, according to a government study in Wednesday’s Journal of the American Medical Association.
Many doctors reserve pancreas transplants for patients who also need a kidney transplant because of kidney failure, a common life-threatening complication of diabetes. Those patients get both organs in one operation.
Transplantation of a pancreas alone is less common and more hotly debated because diabetes without kidney problems can often be controlled with measures far less drastic than surgery and lifelong anti-rejection drugs. Such drugs leave patients prone to infections and often have other serious side effects, including high blood pressure and osteoporosis.
While the number of pancreas-kidney transplants in the United States remained stable at around 900 a year from 1995 to 2000, pancreas-alone transplants nearly quadrupled from 37 in 1995 to 141 in 2002, the study said.
The findings, based on U.S. transplant data on 11,572 diabetes patients, raise important concerns, said Dr. David Harlan, the lead author and a researcher at the National Institute of Diabetes and Digestive and Kidney Diseases.
If additional studies reach the same conclusions, doctors might need to more effectively identify transplant candidates or improve anti-rejection treatments, he said.
The findings suggest doctors should be cautious about the options offered to diabetics without kidney failure, said Dr. Deepak Mital, director of the kidney and pancreas transplant program at Chicago’s Rush University Medical Center. He was not involved in the research.
But transplant specialist Dr. David Sutherland at the University of Minnesota, where many of the nation’s pancreas and kidney transplants are performed, said pancreas-only transplants generally are safe and worth the risk to many diabetics eager to give up multiple daily injections and finger pricks for blood-sugar monitoring.
“I think the trend is going to continue in spite of this article,” he said. “The absolute risk is just not high enough to dissuade patients.”