Background: Islet as well as pancreas transplantation are alternative procedures providing diabetic patients with insulin independence and optimal blood glucose control. Here, we assessed utility of islet transplantation after the failure of the pancreas graft and utility of pancreas transplantation in patients with the declining islet graft.

Material and Method: Three patients with insulin deficient diabetes and problematic hypoglycemia were transplanted with pancreatic islets after failure of their pancreas transplants (IAP patients). Another four patients were transplanted with a pancreas as soon as benefit of islet transplantation vanished (PAI patients). Clinical course was followed up to 3 years after the transplant. Tacrolimus and mycophenolate were used for immunosuppression supplemented with steroids for PAI patients.

Results: All three IAP patients become insulin independent after their first islet transplant. One of them still remains off-insulin 6 months later; while remaining two patients required a second ITx to extend insulin independence over 3 years time. All 4 patients submitted to PAI had uncomplicated clinical course and still maintain optimal blood glucose control without need for insulin more than 3 years after the pancreas transplant. None of the patients developed any de novo HLA antibodies after PAI or IAP transplantation.

Conclusions: Pancreas and islet transplantation are alternative beta replacement transplant procedures, which allowed successfully extending insulin independence in case one type of those therapies had initially failed.