Impact of pancreas transplantation on metabolic control of diabetes mellitus: analysis of scientific evidence
Keywords:
Trasplante de páncreas; Diabetes mellitus; Control glucémico; Inmunosupresión; Rechazo del injerto., Pancreas transplantation; Diabetes mellitus; Glycemic control; Immunosuppression; Graft rejection.Abstract
Introduction: pancreas transplantation constitutes an advanced therapeutic alternative for patients with type 1 diabetes mellitus, allowing restoration of normoglycemia and elimination of exogenous insulin dependence. Despite its potential benefits, the procedure presents significant challenges including limited organ availability, risk of graft rejection and need for permanent immunosuppression.
Objective: to analyze the impact of pancreas transplantation on metabolic control of diabetes mellitus, evaluating patient and graft survival rates, selection criteria and associated complications, based on recent scientific evidence.
Methods: systematized bibliographic review following PRISMA methodology in PubMed, SciELO and MEDLINE databases, period 2019-2024. MeSH terms were used: "pancreas transplantation" AND ("diabetes mellitus" OR "glycemic control"). 423 records were identified, resulting in 28 included studies after applying selection criteria.
Results: patient survival at first year post-transplant ranged from 94.3-97,6 %, at three years 80,1-98,6 % and at five years 74,1-85 %. Graft survival was 81-100 % at first year, 80,1-95,8 % at three years and 71-100 % at five years. Simultaneous pancreas-kidney transplantation (SPK) showed better results than pancreas transplantation alone (PTA). Main exclusion criteria included BMI >30 kg/m², severe heart disease and psychiatric disorders. Average annual rejection rate was 31,6 %.
Conclusions: pancreas transplantation represents an effective therapeutic option for normalizing glycemic control in selected patients with type 1 diabetes mellitus, especially in SPK modality. Rigorous candidate selection through multidisciplinary evaluation is essential to optimize outcomes. Additional studies are required to improve graft survival rates and reduce immunosuppression-associated complications.
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