Thanks to ongoing improvements in the management of diabetes, the age at which severe complications develop, including the need for pancreas transplantation, is increasingly older. That trend brings with it some additional challenges that must be considered when recommending transplantation, said Eelco J.P. de Koning, MD, PhD.
Dr. de Koning will discuss these challenges and other emerging trends during the session Current Role of Pancreas Transplantation in the Treatment of Diabetes, which will be presented from 1:45 p.m. – 3:45 p.m. ET on Saturday, June 26. Dr. de Koning is Professor of Diabetology and Head of the Diabetes Center at Leiden University Medical Center in The Netherlands.
“In order to undergo a pancreas transplantation, you need to be in pretty good health, and at some stage, you get to an age where the surgeons have to determine whether the risk is acceptable for transplantation surgery,” Dr. de Koning said. “Because of better cardiovascular risk management, better glucose management, and advances in diabetes technology, we’re seeing a trend of people getting complications at a later age, so the patients that are potentially eligible for pancreas transplantation are, on average, older.”
At the same time, he said, there is also a trend of increased age among the donors from whom organs are procured for transplantation.
“Older organ donors are more likely to have had a higher BMI (body mass index), for example, or other health problems, so the average quality of the organs is worse, which poses more risk after transplantation,” Dr. de Koning said.
These parallel trends, combined with new technologies contributing to improved glucose control and better risk management, may partially explain why the rate of pancreas transplantations has decreased over the past decade, he said. Additionally, he noted that pancreas transplants are being performed in fewer centers, creating yet another challenge for diabetes care providers when identifying and referring eligible candidates for pancreas transplantation.
“That has all kinds of repercussions because, if you are a diabetologist or endocrinologist in a small hospital, for example, you’re likely to get much less exposure to and know less about pancreas transplantation, such as where to send your patients or what the right indication is,” Dr. de Koning said.
Looking forward, he said it is important for pancreas transplantation centers to reach out to the diabetes care community and share the pros and cons, as well as the successes and failures of pancreas transplantation.
“This is important because there is still a group of patients out there—and I think there are more than we realize—who, despite all the technology, still would benefit in a major way from pancreas transplantation. It’s important to convey that message,” Dr. de Koning said. “Currently, there is too little connection. But with outreach and education, we as a pancreas transplant community can and need to be more proactive about this.”
Also during this session, Ty B. Dunn, MD, of Penn Medicine in Philadelphia, will provide an overview of new indications for pancreas transplantation, and Jon S. Odorico, MD, FACS, of the University of Wisconsin-Madison School of Medicine and Public Health, will discuss pancreas transplantation for type 2 diabetes.
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