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Commentary
December 3, 2003

Isolated Pancreas Transplantation for Type 1 DiabetesA Doctor's Dilemma

Author Affiliations

Author Affiliations: Diabetes Center and General Clinical Research Center, Massachusetts General Hospital, Harvard Medical School, Boston.

JAMA. 2003;290(21):2861-2863. doi:10.1001/jama.290.21.2861

The primary goal for organ replacement therapy, achieved by allografting, should be to preserve life. Some transplantation procedures, such as those for the heart, liver, and lung, are necessary to preserve life, while others (eg, those for the cornea and pancreas) are not. Type 1 diabetes, a uniformly fatal disease prior to the introduction of insulin therapy approximately 80 years ago, represents an interesting case for transplantation. Insulin therapy reduced the occurrence of the metabolic catastrophe ketoacidosis and of death by inanition that characterized diabetes in the preinsulin era; however, until recently, insulin therapy also achieved grossly nonphysiologic metabolic control that was associated with long-term complications, including vision loss, amputations, and kidney failure.1

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