Pancreas Transplantation for Recipients with Type 2 Diabetes Mellitus: Results of an International Survey

Abstract

Background. Pancreas transplantation (PT), historically limited to patients with type 1 diabetes (T1D), is currently performedsuccessfully in selected patients with type 2 diabetes (T2D). However, contemporary practice patterns and eligibilitycriteria for PT in T2D remain incompletely characterized. Methods. The International Pancreas and Islet TransplantAssociation Pancreas Transplant Interest Group developed an electronic survey to assess center-level approaches to patientphenotyping, candidacy, and peri- and posttransplant management for PT in patients with T2D. The survey was distributedto international transplant professionals during an International Pancreas and Islet Transplant Association Pre-Congressmeeting on June 15, 2025. Results. Thirty-seven participants completed the survey. Most respondents’ programs offerPT for T2D only when a kidney transplant is also indicated. Fewer respondents’ programs also offer PT alone (10%), evaluateT2D candidates on a case-by-case basis (3%), or do not offer PT to patients with T2D (10%). Total daily insulin requirementand body mass index (BMI) were the most selected factors in determining eligibility. Considerable variability existed inmetabolic thresholds: 62% of programs reported no C-peptide cutoff, whereas nearly half required a BMI of <30 kg/m2 forC-peptide-positive candidates. Respondents frequently recommend weight-optimization strategies, including lifestyle modification,glucagon-like peptide-1 receptor agonists, and bariatric surgery for candidates exceeding acceptable BMI thresholds.Surgical technique, induction, and maintenance immunosuppression and early posttransplant glycemic managementwere largely uniform between T2D and T1D recipients. Conclusions. International practice reflects broad but heterogeneousadoption of PT for T2D, with most participants restricting its use to candidates requiring kidney transplantation andemphasizing integrated clinical phenotyping approaches.