Hopes Dimming on Pancreas Transplants : Value as a Treatment for Diabetics Limited, Anaheim Convention Told

Pancreas transplants, once touted as a possible cure for diabetes, now appear to be a source of treatment for only a limited number of diabetics, while research into other treatments and prevention of the disease holds more promise, a Harvard Medical School professor said Tuesday.

Dr. George F. Cahill, in an interview at the American Diabetes Assn. convention in Anaheim, questioned whether doctors are “justified in undertaking a major procedure on an already compromised individual” whose complications from diabetes cannot be reversed by the operation and who must take anti-rejection drugs for the rest of his life.

The transplant operations, now being done on an experimental basis, will probably never surpass 6,000 a year and should be limited to teaching hospitals so that researchers can learn more about diabetes from the procedure, he said. He does not foresee the operation becoming a common procedure performed at community hospitals, Cahill added.

Diabetes is a disease in which the body does not properly convert sugar, starches and other food into the energy needed for life. It afflicts 11 million Americans and can often lead to severe complications such as kidney failure, heart disease, blindness or nerve damage.

Doctors have been studying the possibility of pancreas transplants for people with insulin-dependent diabetes. In that disease, the body’s auto-immune system destroys healthy tissue, including cells in the pancreas, where insulin is manufactured.

Insulin is necessary to metabolize sugar and other foods. As a result, digested sugars build up to high levels in the blood unless the diabetic takes daily insulin injections.

Cahill, one of several speakers at a symposium on the future of pancreas transplants, said the best subjects for pancreas transplants are young diabetics who have just been diagnosed with the disease and who have not yet developed any complications.

But if he had to treat a 14-year-old child who had just been diagnosed as diabetic, Cahill said, he would not agree to a transplant operation. Even if the operation is successful, the child would have to take immuno-suppressive drugs, with potentially severe side effects, for the rest of his life to prevent rejection, he said.

“I would take the odds that with strict control” of blood sugar, insulin and diet, the child would keep the disease well-regulated and reduce the chances of complications, Cahill said.

In addition, he said, transplanted organs carry the risk of infecting the recipient with hepatitis or even acquired immune deficiency disease.

“That’s the last thing you want to do to a young child,” Cahill said.

Still, transplants of the whole or partial pancreas or of cells within the pancreas are valuable for research, Cahill said, referring to ongoing studies at the University of Minnesota’s pancreas transplant program.

According to information supplied by the American Diabetes Assn., about 800 pancreas transplants have been performed worldwide. The University of Minnesota’s transplant program director has said that the survival rate averages about 45% but could improve to about 80% within a few years.

Cahill said he sees hope for a diabetes cure in prevention, rather than transplants.

The focus must be on learning what predisposes a person to the disease, he said. Researchers need to discover how to keep the body’s auto-immune system from destroying pancreatic cells.

He added that researchers might be only five to 10 years away from such a discovery.