Transplantation of Pancreas and Islets

Total endocrine replacement therapy for insulin-dependent diabetes mellitus is possible by transplantation of either immediately vascularized pancreatic allografts or the islets of Langerhans as free grafts. The rationale for these treatments rests on the hypothesis that the microangiopathic and other lesions associated with diabetes mellitus are secondary to disordered metabolism. Presumably, perfect control of carbohydrate metabolism would prevent the development or halt the progression of the lesions affecting the eye, kidney, nervous, and other systems. Although the point is controversial, clinical and experimental observations support this hypothesis (see reviews by Brownlee and Cahill, 1979; Tchobroutsky, 1978; Mauer et al., 1981).