Combined liver and islet transplantation in hepatogenous diabetes, cluster exenteration, and cirrhosis with type 1 diabetes

Marco Infante, Nathalia Padilla, Sri Gita Madiraju, Ana Alvarez, David Baidal, Camillo Ricordi, Rodolfo Alejandro

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Liver cirrhosis is an increasing global public health burden, representing a relevant cause of morbidity and mortality worldwide. Hepatogenous diabetes (HD) is defined as an acquired condition of impaired glucose regulation due to the loss of liver function caused by cirrhosis, which exacerbates the poor long-term prognosis of cirrhotic patients. Nevertheless, HD has not yet been considered as a distinct clinical entity separated from classical type 2 diabetes mellitus. However, prompt diagnosis and treatment of HD may improve the clinical outcomes in cirrhotic patients. This chapter aims to describe the current understanding of epidemiologic and pathophysiological features of HD, along with the current diagnostic and therapeutic strategies for this disease, particularly focusing on the studies evaluating the effectiveness of liver transplantation alone or in combination with pancreatic islet transplantation. The safety and efficacy of combined liver and islet transplantation have been demonstrated in patients undergoing upper abdominal exenteration and liver replacement due to unresectable tumors. In theory, liver transplantation should reverse impairment in glucose regulation and HD in patients with liver cirrhosis, although the results from different studies are not clear. On the other hand, only a few studies have evaluated the effectiveness of combined liver and islet transplantation in cirrhotic patients with type 1 diabetes mellitus and type 2 diabetes mellitus/HD, showing promising but tentative results. In conclusion, prospective randomized clinical trials will be needed in the future to better understand who are the best candidates for either liver transplantation alone or combined liver and islet transplantation.

Original languageEnglish (US)
Title of host publicationTransplantation, Bioengineering, and Regeneration of the Endocrine Pancreas
Subtitle of host publicationVolume 1
PublisherElsevier
Pages439-453
Number of pages15
ISBN (Electronic)9780128148334
ISBN (Print)9780128148341
DOIs
StatePublished - Jan 1 2019

Keywords

  • Combined liver-islet transplantation
  • Combined liver-pancreas transplantation
  • Hepatogenous diabetes
  • Islet transplantation
  • Liver cirrhosis
  • Liver transplantation
  • Type 1 diabetes mellitus
  • Type 2 diabetes mellitus

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

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