Since pancreas transplantation has been shown to be very effective in controlling acute and chronic complications of diabetes over long periods of time, and islet transplantation has not, pancreas transplantation must be viewed as the more effective option. However, individual recipients who do not want to undergo the extensive surgery and potentially complicated postoperative course of organ transplantation may logically choose islet transplantation. This should be done, however, with the full knowledge that the majority of islet recipients need to return to insulin-based treatment and that intrahepatic islet transplant recipients do not have restored glucagon secretion during hypoglycemia. The latter is a significant issue given the number of islet transplant recipients who return to insulin treatment and are once again at-risk for hypoglycemia. There are few data that address the impact of islet transplantation on the secondary complications of diabetes mellitus. However, it can be anticipated that those islet transplant patients who are successful in maintaining islet function and normal levels of hemoglobin A1c should have the same beneficial effects on secondary complications of diabetes that has been demonstrated in successful recipients of pancreas transplantation.
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