Pancreas Transplant for Type II Diabetes Mellitus Patients

Additional Info

• Audio File:uab/ua222.mp3
• Doctors:Anderson, Douglas
• Featured Speaker:Douglas Anderson, MD
• CME Series:Quality and Outcomes
• Post Test URL:https://cmecourses.som.uab.edu/mod/quiz/view.php?id=5406
• Guest Bio:Dr. Douglas Anderson grew up in Franklin, Tennessee, just south of Nashville. He attended Vanderbilt University, where he received his bachelor’s and master’s degrees in biomedical engineering. After graduation, he remained at Vanderbilt to attend medical school before relocating to Atlanta in 2009. Once in Atlanta, he completed his residency in general surgery and fellowship in transplant surgery at Emory University. While there, he spent two years in the Emory Transplant Center laboratory researching co-stimulation blockade-based immunosuppression strategies in a pre-clinical model of kidney transplantation. 
  
  Learn more about Douglas Anderson, MD 
  
  Release Date: November 15, 2021
  Expiration Date: November 14, 2024
  
  Disclosure Information:
  
  Planners:
  Ronan O’Beirne, EdD, MBA
  Director, UAB Continuing Medical Education
  
  Katelyn Hiden
  Physician Marketing Manager, UAB Health System
  
  The planners have no relevant financial relationships with ineligible companies to disclose.
  
  Faculty:
  Douglas J. Anderson, MD, MS, FACS
  Assistant Professor in Transplantation Surgery,
  
  Dr. Anderson has no relevant financial relationships with ineligible companies to disclose.
  
  There is no commercial support for this activity.
• Transcription:Medcast Intro: UAB Medcast is an ongoing medical education podcast. The UAB division of continuing education designates that each episode of this enduring material is worth a maximum of 0.25 AMA PRA category one credit. To collect credit, please visit UABmedicine.org/medcast and complete the episode's posttest.
  
  Melanie Cole (Host): Welcome to UAB Medcast. I'm Melanie Cole. And today we're talking about pancreas transplant for Type 2 diabetes. Joining me is Dr. Douglas Anderson. He's the Program Director and Abdominal Transplant Surgery Fellowship at UAB Medicine. Dr. Anderson, thank you so much for being with us today. This is really a fascinating topic.
  
  So as we get into it, I'd like you to tell us a little bit about what's traditionally been the situation with pancreas transplants and diabetes. Has this been contraindicated for diabetes Type 2, Type 1? Tell us a little bit about the history and evolution of this.
  
  Douglas Anderson, MD (Guest): Well, sure. Well, thank you for having me, first of all. Pancreas transplant for treatment of diabetes has been around for some time. It is one of the less common transplants that we do. Far less common than say kidney, liver or heart transplant. And historically, we've talked about it primarily in the setting of Type 1 diabetes.
  
  So we can think of diabetes as Type 1 versus Type 2 as being issues with either production of insulin or the body's response to insulin. And so in the past, we primarily talked about pancreas transplantation for Type 1 diabetics who actually have the defect in insulin production. And so by giving them a new pancreas, we replace that production, and cure their diabetes. In the case of Type 2 diabetics, when it's an issue of the body's response to insulin, it was long felt that the additional production provided by a new pancreas may not help because the body is not going to respond to it in the normal way, just as it doesn't respond to its own insulin production. However, what we found is that in a select group of Type 2 diabetics, giving them additional insulin production can actually improve their outcomes, get them insulin independent, and reduce their risk of diabetic complications.
  
  And there's now data suggest that their outcomes may be just as good as the Type 1 diabetics, that we've traditionally considered for pancreas transplant.
  
  Host: That is so interesting. And as we think of insulin resistance and you made such good sense talking about production versus resistance but how for the select group of patients. And I think that's one of the keys that we're talking about here today. So, as you're talking, us about the role for pancreas transplant in Type 2 diabetes, how important is careful patient selection criteria? Give us some of the clinical indications, Doctor that make this a viable option for these patients.
  
  Dr. Anderson: Sure. I think it's also worth highlighting that advances in insulin therapy over the past decades have really made huge strides in the care of diabetic patients. And so, often what we're talking about pancreas transplant, we're talking about patients who also have kidney disease.
  
  When you talk about diabetics in general, there may not be huge benefits for a pancreas transplant outside of certain situations, because essentially you're trading their insulin therapy for the immunosuppression that comes with getting any transplant. And so you're trading one chronic medication management for another. However, for a certain group of patients who have really difficult to control diabetes or hypoglycemic unawareness with their insulin regimen or who have kidney failure and are going to be getting a kidney transplant and therefore on immunosuppression anyway, those patients can get the benefits from a pancreas transplant.
  
  Specifically talking about Type 2 diabetics, the things that we really pay attention to is what is their insulin requirement, because if they require large amounts of insulin to control their blood sugars, giving them the additional production from a pancreas transplant may not be able to overcome that resistance.
  
  So, if they're requiring 120 units a day of insulin, for example, giving them a new pancreas and some additional production is not going to be able to overcome their body's insulin resistance. However, if they're only requiring say 40 or 50 units a day, giving them the additional production can probably cover that deficit and allow them to become insulin independent post-transplant. The other thing that goes along with that is primarily metabolic syndrome and their weight management. For patients who are morbidly obese, have high insulin requirements, there's probably better options for treating their diabetes, such as bariatric surgery. But for a group of patients who are well controlled on a low insulin requirement and otherwise doing well, don't have any major heart or lung issues, no cancer history; pancreas transplant does provide an opportunity to gain insulin independence and reduce their risk of many of those diabetic complications in the long term.
  
  Host: That is so cool, really. This is so interesting. I'm an exercise physiologist, Dr. Anderson. So, I really hear you when you're speaking about this. Now has there been a universal listing criteria or has the definition of Type 2 diabetes been left to the discretion of individual reporting centers? Because you just listed some criteria, but yet that can go on very many ends of the scale.
  
  Dr. Anderson: No, there's no universal criteria. And that's true of really all areas of transplant. The decision to list a patient for a transplant or consider a patient for a transplant is made by individual centers. While there are general consensus in a lot of areas. And there are some specific requirements from the United Network for Organ Sharing, which manages the donation process in the United States.
  
  Really the decision to list a patient, is up to the individual center. Really the only dictated criteria for listing for a pancreas transplant is you have to have a diagnosis of diabetes and be on insulin. So for patients who are on oral agents, or diet controlled diabetes, would find it very difficult to get listed for a pancreas transplant. But in terms of specific criteria, in terms of weight or insulin requirement or other medical problems; those decisions are made at the center level.
  
  And so even though one center may say, we don't think you're a good candidate, another center may disagree and be willing to list you.
  
  Host: Well, that's why we're talking about this, because tell us about UAB and how you're expanding the pancreas transplant program so more Type 2 diabetes patients have access to this fascinating option.
  
  Dr. Anderson: Well, that's exactly the case is that we have a large population of patients who have Type 2 diabetes and kidney disease. And so, we've traditionally seen these patients and talked to them about kidney transplant. But as the data has become available to suggest that they have a benefit potentially for pancreas transplant as well, we're interested in offering that to more of our patients. And so, making this available to Type 2 diabetics, which is a larger proportion of the overall diabetes population, we think has the potential to benefit a lot of people.
  
  Host: Well, it certainly does. And before we wrap up, what would you like to add? What would you like to tell other providers about the need for this multidisciplinary approach for these patients? As you mentioned, there are many factors in a multimodal approach really to help them with their diabetes, but also when you feel it's important someone refer to UAB Medicine.
  
  Dr. Anderson: That's a great question and what I would put out there is that we're happy to hear about referrals and screen patients and evaluate patients who may benefit from transplant. And I think for, patients with diabetes, the key factors that we would look for in, in who would really benefit the most from a pancreas transplant; again, are those patients who have difficult or brittle diabetes, specifically hypoglycemic unawareness because that can be a life-threatening problem. And patients who have kidney disease. And so patients who may be headed towards a kidney transplant in the future, that's a patient that can potentially benefit, as well.
  
  And will we see those patients in the clinic and can talk to them about pancreas transplants at the same time. For diabetics there's even some data that suggests that their outcomes from their kidney transplant may be better, if they get a pancreas transplant at the same time so that their diabetes is better controlled. And so, definitely want to see any patient who could potentially benefit from pancreas transplant.
  
  Host: Really what an informative episode. Thank you so much, Dr. Anderson for joining us today. And a physician can refer a patient to UAB Medicine by calling the mist line at 1-800-UAB-MIST. Or by visiting our website at UABmedicine.org/physician. That concludes this episode of UAB Medcast. I'm Melanie Cole. Thanks so much for listening.
• Hosts:Melanie Cole, MS