Islet Transplantation as a Treatment for Diabetes

To the Editor: We respectfully disagree with two points in Robertson's comprehensive review of islet transplantation (Feb.12 issue) 1 : the assertions that patients with diabetes and autonomic insufficiency have a "dramatically shortened life span" and that transplantation necessarily reduces the rate of death.In the cited articles and an additional article by Navarro et al., 2 most persons with diabetes had autonomic insufficiency.In fact, autonomic insufficiency lost its statistical significance after adjustment for renal dysfunction and cardiovascular disease in two population-based studies. 3,4When Navarro et al. compared pancreas-transplant recipients with medically treated patients, mortality rates were indistinguishable.