TY - JOUR
T1 - Pancreas Transplantation for Recipients with Type 2 Diabetes Mellitus
T2 - Results of an International Survey
AU - Fridell, Jonathan A.
AU - Uva, Pablo D.
AU - Kukla, Aleksandra
AU - DeLonais-Parker, Ava
AU - Mansuri, Rushda Faruk
AU - Axelrod, David
AU - Dunn, Ty
AU - Niederhaus, Silke V.
AU - Parsons, Ronald
AU - Pleass, Henry
AU - Paraskevas, Steven
AU - Rickels, Michael R.
AU - Stratta, Robert J.
AU - Ventura-Aguiar, Pedro
AU - Woodside, Kenneth J.
AU - Lentine, Krista L.
N1 - Copyright © 2026 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.
PY - 2026/7
Y1 - 2026/7
N2 - BACKGROUND: Pancreas transplantation (PT), historically limited to patients with type 1 diabetes (T1D), is currently performed successfully in selected patients with type 2 diabetes (T2D). However, contemporary practice patterns and eligibility criteria for PT in T2D remain incompletely characterized.METHODS: The International Pancreas and Islet Transplant Association Pancreas Transplant Interest Group developed an electronic survey to assess center-level approaches to patient phenotyping, candidacy, and peri- and posttransplant management for PT in patients with T2D. The survey was distributed to international transplant professionals during an International Pancreas and Islet Transplant Association Pre-Congress meeting on June 15, 2025.RESULTS: Thirty-seven participants completed the survey. Most respondents' programs offer PT for T2D only when a kidney transplant is also indicated. Fewer respondents' programs also offer PT alone (10%), evaluate T2D candidates on a case-by-case basis (3%), or do not offer PT to patients with T2D (10%). Total daily insulin requirement and body mass index (BMI) were the most selected factors in determining eligibility. Considerable variability existed in metabolic thresholds: 62% of programs reported no C-peptide cutoff, whereas nearly half required a BMI of <30 kg/m
2 for C-peptide-positive candidates. Respondents frequently recommend weight-optimization strategies, including lifestyle modification, glucagon-like peptide-1 receptor agonists, and bariatric surgery for candidates exceeding acceptable BMI thresholds. Surgical technique, induction, and maintenance immunosuppression and early posttransplant glycemic management were largely uniform between T2D and T1D recipients.
CONCLUSIONS: International practice reflects broad but heterogeneous adoption of PT for T2D, with most participants restricting its use to candidates requiring kidney transplantation and emphasizing integrated clinical phenotyping approaches.
AB - BACKGROUND: Pancreas transplantation (PT), historically limited to patients with type 1 diabetes (T1D), is currently performed successfully in selected patients with type 2 diabetes (T2D). However, contemporary practice patterns and eligibility criteria for PT in T2D remain incompletely characterized.METHODS: The International Pancreas and Islet Transplant Association Pancreas Transplant Interest Group developed an electronic survey to assess center-level approaches to patient phenotyping, candidacy, and peri- and posttransplant management for PT in patients with T2D. The survey was distributed to international transplant professionals during an International Pancreas and Islet Transplant Association Pre-Congress meeting on June 15, 2025.RESULTS: Thirty-seven participants completed the survey. Most respondents' programs offer PT for T2D only when a kidney transplant is also indicated. Fewer respondents' programs also offer PT alone (10%), evaluate T2D candidates on a case-by-case basis (3%), or do not offer PT to patients with T2D (10%). Total daily insulin requirement and body mass index (BMI) were the most selected factors in determining eligibility. Considerable variability existed in metabolic thresholds: 62% of programs reported no C-peptide cutoff, whereas nearly half required a BMI of <30 kg/m
2 for C-peptide-positive candidates. Respondents frequently recommend weight-optimization strategies, including lifestyle modification, glucagon-like peptide-1 receptor agonists, and bariatric surgery for candidates exceeding acceptable BMI thresholds. Surgical technique, induction, and maintenance immunosuppression and early posttransplant glycemic management were largely uniform between T2D and T1D recipients.
CONCLUSIONS: International practice reflects broad but heterogeneous adoption of PT for T2D, with most participants restricting its use to candidates requiring kidney transplantation and emphasizing integrated clinical phenotyping approaches.
UR - https://www.scopus.com/pages/publications/105041863099
UR - https://www.scopus.com/inward/citedby.url?scp=105041863099&partnerID=8YFLogxK
U2 - 10.1097/TXD.0000000000001963
DO - 10.1097/TXD.0000000000001963
M3 - Article
C2 - 42256091
AN - SCOPUS:105041863099
SN - 2373-8731
VL - 12
SP - e1963
JO - Transplantation Direct
JF - Transplantation Direct
IS - 7
M1 - e1963
ER -