School of Medicine, University of Manchester, Manchester M13 9PL, United Kingdom.
Faculty of Medicine in Hradec Kralove, Charles University, CZ-121 08 Prague 2, Czech Republic.
Eur J Endocrinol. 2023 Apr 5;188(4):R73-R87. doi: 10.1093/ejendo/lvad032.
Successful pancreas or islet transplantation is currently the only cure for type 1 diabetes mellitus. Since the first pancreas transplant in 1966, there have been various refinements of surgical technique along with improved immunosuppressive regimens, resulting in significantly improved outcomes, with contemporary research into graft monitoring and newer biomarkers, potentially lengthening graft survival rates further. Patients with insulin-dependent diabetes mellitus who are eligible for pancreas or islet transplantation represent a select group, the tip of the iceberg for a significant global diabetes disease burden. In the last 50 years, there have been quantum advances in alternative technologies in diabetes therapy, both experimental and translational. Further development and improved access are required to treat the larger proportion of people suffering from diabetes. Emerging stem cell therapy is still experimental whereas alternatives including automated insulin delivery systems and islet cell transplantation are already used in some countries. Whilst automated insulin delivery systems have increased in efficacy, they still do not achieve the near physiological control of blood sugar, which can be achieved by successful pancreas or islet transplantation. This state-of-the-art review provides a summary of pancreas and islet transplantation to its current place in diabetes therapy, along with alternative and future therapies, including the obstacles associated with the dissemination of these new therapies. With the advent of these modern cellular and technological advances, this review addresses the question: are we entering an era where whole organ pancreas transplantation could be replaced entirely by modern technological advances in diabetes therapy?
成功的胰腺或胰岛移植目前是治疗 1 型糖尿病的唯一方法。自 1966 年首例胰腺移植以来，随着手术技术的不断改进和免疫抑制方案的改善，其结果显著改善，目前对移植物监测和新型生物标志物的研究，可能进一步延长移植物的存活率。有资格进行胰腺或胰岛移植的胰岛素依赖型糖尿病患者代表了一个特定的群体，是全球糖尿病疾病负担的冰山一角。在过去的 50 年中，糖尿病治疗的替代技术在实验和转化方面都取得了重大进展。需要进一步开发和改善获取途径，以治疗更多患有糖尿病的人。新兴的干细胞疗法仍处于实验阶段，而包括自动胰岛素输送系统和胰岛细胞移植在内的替代疗法已在一些国家使用。虽然自动胰岛素输送系统的疗效有所提高，但它们仍无法实现成功的胰腺或胰岛移植所实现的接近生理的血糖控制。本文对胰腺和胰岛移植的最新进展进行了综述，介绍了目前糖尿病治疗中替代和未来的治疗方法，包括这些新疗法传播所面临的障碍。随着这些现代细胞和技术的进步，本文探讨了这样一个问题：我们是否正进入一个时代，现代糖尿病治疗的技术进步可以完全取代整个器官的胰腺移植？
