الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
With the recent advances in immunosuppression and surgical techniques of pancreas transplantation, type 1 diabetes mellitus is routinely and successfully treated by surgery in thousands of patients each year. Despite the progress and promise of islet cell transplantation, whole-pancreas transplantation remains the only insulin-replacement therapy to reliably restore normoglycemia in the long term.
The cost of this benefit is the risk of surgery and lifelong immunosuppression. Pancreas transplantation has exceeded the initial expectations of establishing euglycemia and improving the quality of life World-wide living donors comprise a small percentage of pancreas transplants The results of pancreas transplantation have improved remarkably since the mid-1980s, and the likelihood of success now approaches that of other solid organ transplants. Because pancreas transplants are not immediately lifesaving, except in patients with profound hyperglycemic unawareness, the serious side effects of lifelong immunosuppression must be weighed against the somewhat unpredictable sequelae of insulin-managed diabetes. Currently, transplantation is limited at most centers to diabetics who require a kidney transplant or have already had one. Prevention of the microvascular complications of diabetes by pancreas transplantation seems likely but has not been proved by randomized studies. Advanced complications are much less likely to be stabilized or reversed. The morbidity and monetary expense associated with conventional insulin therapy, along with its complicating factors, must also be compared with those of successful transplantation and immunosuppression to determine the eventual place of pancreatic and islet transplantation. Possibly as important a consideration as the impact of a pancreas transplant on microvascular complications is its potential for improving quality of life. Recipients of successful pancreatic allografts usually report increased vitality, greater capability for self-care, and general improvement in quality of life.
Islet cell transplantation has raised hope for a cure of diabetes for over three decades. The failure to quickly reach this goal has been an enormous disappointment to scientists, clinicians, and patients. However, the field of islet transplantation has evolved and matured tremendously and has witnessed significant progress, and the results of recent human islet allotransplantation in patients with type 1 diabetes mellitus are encouraging. At the dawn of the millenium, with the synergy of a number of important innovative tools, including stem-cell expansion, immunomodulation, and gene therapy, we enter a solid foundation for expanding fundamental research and for translating basic knowledge into clinical applications. The challenges will be many, but the potential benefits for patients with type 1 diabetes will be extraordinary. Continued international collaboration will further stimulate excitement in the field as innovative solutions are created to meet the remarkable challenges that lie ahead.