This is the current release of the guideline.

The guideline was originally approved in November 1999.

American Diabetes Association (ADA) position statements are reissued annually.

1. Pancreas transplantation should be considered an acceptable therapeutic alternative to continued insulin therapy in diabetic patients with imminent or established end-stage renal disease who have had or plan to have a kidney transplant, because the successful addition of a pancreas does not jeopardize patient survival, may improve kidney survival, and will restore normal glycemia. Such patients also must meet the medical indications and criteria for kidney transplantation and not have excessive surgical risk for the dual transplant procedure. Medicare and other third-party payers of medical care should include coverage for pancreas transplant procedures meeting these criteria. The pancreas transplant may be done simultaneous with, or subsequent to, a kidney transplant. Pancreas graft survival is better when done simultaneously with a kidney transplant.
2. In the absence of indications for kidney transplantation, pancreas transplantation should only be considered a therapy in patients who exhibit these three criteria: 1) a history of frequent, acute, and severe metabolic complications (hypoglycemia, hyperglycemia, ketoacidosis) requiring medical attention, 2) clinical and emotional problems with exogenous insulin therapy that are so severe as to be incapacitating, and 3) consistent failure of insulin-based management to prevent acute complications. Program guidelines for ensuring an objective multidisciplinary evaluation of the patient's condition and eligibility for transplantation should be established and followed. Third-party payer coverage is appropriate only where such guidelines and procedures exist.
3. Pancreatic islet cell transplants hold significant potential advantages over whole-gland transplants. However, at this time, islet cell transplantation is an experimental procedure, also requiring systemic immunosuppression, and should be performed only within the setting of controlled research studies.

None provided

The type of supporting evidence is not specifically stated for each recommendation.

Not applicable: The guideline was not adapted from another source.

1999 Nov (republished 2004 Jan)

American Diabetes Association - Professional Association

The American Diabetes Association (ADA) received an unrestricted educational grant from LifeScan, Inc., a Johnson and Johnson Company, to support publication of the 2004 Diabetes Care Supplement.

Professional Practice Committee

Authors of Position Statement, Initial Draft: R. Paul Robertson, MD: Connie Davis, MD; Jennifer Larsen, MD; Robert Stratta, MD; David E.R. Sutherland, MD

Not stated

This is the current release of the guideline.

The guideline was originally approved in November 1999.

American Diabetes Association (ADA) position statements are reissued annually.

The recommendations in this paper are based on the evidence reviewed in the following publication:

• Robertson RP, Davis C, Larsen J, Stratta R, Sutherland DER: Pancreas and islet transplantation for patients with diabetes (Technical Review). Diabetes Care 2000;23:112-6.

Print copies: Available from the American Diabetes Association (ADA), 1701 North Beauregard Street, Alexandria, VA 22311.

None available

This summary was completed by ECRI on November 1, 1998. The information was verified by the guideline developer on December 15, 1998. This summary was updated by ECRI on April 1, 2001, January 29, 2002, April 21, 2003, and April 1, 2004.