Patients suffering from type 1 diabetes are at high risk of death. Our aim is to design a multicenter, prospective and randomized study comparing pancreas versus islet transplantation in type 1 diabetic patients.

Several years ago, a multicenter, international, prospective and randomized trial (PANCREAS study; sponsor University Hospital of Nantes) was designed in order to compare the efficacy and safety (including death and end-stage renal failure) of pancreas transplantation versus optimized insulin therapy in type 1 diabetic patients with macro-proteinuria and mild renal dysfunction. Unfortunately, this trial was stopped because of lack of inclusions. During the last 15 years, pancreas transplantation alone as well as islet transplantation demonstrated their capacity to achieve long-term insulin independence and/or to significantly improve the ß score. Recently, a trial comparing the metabolic efficiency of islet transplantation to intensive insulin therapy for type 1 diabetes's treatment (TRIMECO study; sponsor University Hospital of Grenoble) clearly proved superiority of islet transplantation. Nowadays, pancreas transplant alone is performed worldwide but numbers remain low as compared to pancreas transplantation performed simultaneously with a kidney. Insulin independence is obtained immediately after surgery and persists within years in almost 60-70% of cases. Morbidity of this procedure is high, technical complications account for 10-20% of failures and mortality remains low. Islet transplantation is performed in selected cases and numbers are also very low. Transplantation requires more than one transplant to achieve insulin independence or an improvement of the ß score. Almost 50% of cases achieve these two goals beyond 3 years. Morbidity is lesser than pancreas transplantation. Differing from pancreas transplantation, islet transplantation is not approved by national insurances in several nations over the world and paradoxically is still considered an experimental procedure. Today we have these two therapeutic options to treat a type 1 diabetic patient resistant or refractory to current optimized medical therapy.

The transplant community involved in these two procedures should think to design a large prospective and international trial comparing pancreas versus islet transplantation, including not only short but also long-term end-points to scientifically determine the best procedure to offer to our diabetic patients.

CITATION INFORMATION: Cantarovich D, Benhamou P.-Y. A Multicenter, Prospective and Randomized Trial Comparing Pancreas versus Islet Transplantation: Should We Do It Now? Am J Transplant. 2017;17 (suppl 3).

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