Review Article 1

Progressive loss of insulin secretion caused by anautoimmune process that destroys pancreatic β-cells in genetically susceptible patients heralds a life-long dependence on insulin therapy. Despite careful treatment, half of type 1 diabetic patients suffer from chronic neurovascular complications. Evidence indi-cates that these microangiopathic lesions are sec-ondary to imperfect control of glycemia. In 1993, the Diabetes Control and Complications Trial clearly showed that intensive insulin therapy with a decrease in glycated hemoglobin significantly reduced the risk of microvascular complications.(1) However, the improvement in glycemic control was associated with a 3-fold increased risk of severe hypoglycemia and did not completely avoid chronic diabetic com-plications. An attractive alternative is to transplant insulin-producing tissue, either the whole/segmental pancreas or isolated islets, which can offer a more physiological approach for precise restoration of glu-cose homeostasis, thereby reversing the metabolic and neurovascular complications of diabetes. Compared with vascularized pancreatic grafts