April 28, 2026
Diabetes management has advanced significantly in recent decades, allowing many people with diabetes to achieve glycemic control with insulin therapy, medication, diet and exercise. But those who cannot manage their glucose levels may have another option: a pancreas transplant or a pancreas-kidney transplant.
Referral guidance varies for people with type 1 and type 2 diabetes, as does eligibility criteria. In this article, Nitin N. Katariya, M.D., an abdominal transplant surgeon, and Lavanya Kodali, M.B.B.S., M.D., a transplant nephrologist, share their approach to pancreas transplant for people with diabetes. Both physicians care for patients at Mayo Clinic's campus in Phoenix, Arizona.
1. Pancreas-only transplant can help people with type 1 diabetes get off insulin
Mayo Clinic offers pancreas-only transplantation for people with type 1 diabetes. "The transplant can give them more control over their blood sugars and potentially help get them off insulin and into a better quality of life," Dr. Katariya explains.
Consider a referral for these individuals if they are 65 or younger and unable to manage their blood sugars despite being on an insulin pump. Red flags include:
- Recurrent, severe episodes of diabetic ketoacidosis.
- Frequent hypoglycemic unawareness.
There is no strict A1C cutoff for people with type 1 diabetes. However, a hemoglobin A1C of 8.0 or below is ideal.
If the patient has kidney disease, a simultaneous pancreas-kidney (SPK) transplant may be a better option, Dr. Kodali says.
2. People with type 1 diabetes or type 2 diabetes may benefit from simultaneous pancreas-kidney transplant
Anyone with kidney disease and type 1 diabetes or type 2 diabetes who is insulin dependent with poor glucose control should at least talk to a transplant specialist about the possibility of SPK.
To be eligible for SPK, patients should be 65 or younger and have:
- A body mass index (BMI) of less than 30 for people with type 2 diabetes or less than 35 for people with type 1 diabetes.
- An insulin requirement of less than 1 unit/kg/day.
- An A1C of 8.0 or below, ideally.
- A glomerular filtration rate (GFR) of less than 20.
Transplant specialists pay special attention to BMI and insulin dependence metrics in patients with type 2 diabetes. Patients who don't meet the BMI and insulin dependence criteria are unlikely to gain significant benefit from a pancreas-kidney transplant, because they won't be able to come off insulin completely. Weight-loss medications such as GLP-1 agonists can help patients optimize their BMI.
An A1C higher than 8.0 does not necessarily exclude patients from SPK, Dr. Katariya adds. "If their A1C exceeds that level, we will ask them to work with their local care team to optimize their glucose management, with the goal of decreasing their risk of secondary complications," he says.
3. Early referral can help preserve transplant options
Early referral allows the transplant team to identify any medical and psychosocial concerns to address prior to putting patients on the transplant list.
"Waiting — particularly if a patient is already on dialysis — increases the chance they will develop cardiovascular complications," Dr. Kodali says. "Ideally, we want to evaluate patients before they are on dialysis."
The evaluation includes a thorough health history and medical exams to:
- Confirm that the patient cannot achieve glucose control without a transplant.
- Identify comorbidities such as heart disease, lung disease and premalignancies.
- Assess the patient's ability to tolerate the transplant, recovery and immunosuppressant therapy.
- Ensure the patient has the support and resources needed post-transplant.
4. Pancreas transplant and SPK are the definitive treatments for select patients with diabetes. But there are alternatives
Organ transplantation can help many people with diabetes get off insulin and avoid diabetic complications such as end-organ damage, cardiovascular disease, kidney failure and retinopathy. But it is also a major surgery requiring lifelong immunosuppression therapy. Both physicians say they are optimistic about experimental therapies that may expand future treatment options.
"Researchers are exploring new ways to use islet cell transplantation for diabetes treatment in select patients," Dr. Kodali says. "For example, they are investigating ways to improve islet cell durability after transplant and recently developed a way to derive islets from stem cells."
Researchers also are looking at monoclonal antibodies to delay onset or progression of type 1 diabetes, especially in children, she adds. In the longer term, advances in 3D printing techniques could one day lead to broader availability of islet cells and organs for people with diabetes.
A full episode on pancreas transplantation is available with Dr. Kataryia and Dr. Kodali on Mayo Clinic Talks.
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