Pancreas and Islet Transplants: How New Preservation Methods Are Improving Outcomes

For decades, pancreas transplantation and islet transplantation were seen as rival approaches to treating Type 1 diabetes. Today, researchers recognize them as complementary strategies—each suited to different patient needs and circumstances. Whole-organ pancreas transplantation remains the established standard, but islet transplantation has matured into a viable clinical option for selected patients, broadening the toolkit available to transplant specialists.

One of the biggest challenges in transplantation is keeping donated organs healthy during the time between recovery and surgery. Historically, cold storage—essentially keeping organs in a refrigerated solution—was the only option. But this approach has limitations: cold storage slows metabolism but doesn't prevent all the damage that occurs when organs are without oxygen and blood flow.

Researchers are now transitioning to dynamic preservation platforms that actively maintain organ function during storage. These include hypothermic machine perfusion (HMP), which uses controlled cooling and circulation; oxygenated hypothermic perfusion (HOPE), which adds oxygen to the preservation process; normothermic ex vivo perfusion (NEVP), which warms the organ while maintaining it outside the body; and normothermic regional perfusion (NRP), which restores near-normal conditions in donated organs. Early evidence suggests these dynamic methods improve metabolic recovery and may enhance islet isolation outcomes compared to traditional cold storage alone. HOPE, in particular, shows promise in reducing ischemia-reperfusion injury—the damage cells sustain when blood flow is restored after a period without oxygen.

People who receive transplants must take immunosuppressive medications to prevent rejection, but these drugs come with costs: long-term use can harm the kidneys and disrupt metabolism. Researchers are exploring more precise, tolerance-inducing approaches that could reduce these side effects while maintaining graft survival.

Emerging strategies include regulatory T-cell (Treg) therapies, which harness the body's own immune regulatory cells; costimulation blockade, which targets specific immune activation pathways; and biomaterial-enabled local immunoprotection, which shields the transplanted tissue locally rather than suppressing the immune system throughout the entire body. These approaches aim to achieve a better balance: protecting the graft while minimizing the broader health impacts of chronic immunosuppression.

The convergence of improved organ preservation and refined immunosuppression strategies represents a significant evolution in transplant medicine. As these technologies mature and evidence accumulates, they have the potential to expand access to transplantation, improve long-term outcomes, and reduce the burden of immunosuppressive medications on recipients' overall health. The field continues to advance, with researchers working to identify biomarkers that predict which patients will benefit most from each approach.

Source: Journal of clinical medicine. Evidence type: PubMed indexed literature. Type1Cure is an information and intelligence hub, not a medical advice service. This article summarizes published research and does not provide diagnosis, treatment, or personal medical guidance. Always talk to your own care team before changing anything about your Type 1 diabetes management.