The Elusive Definition of Type 2 Diabetes in the Context of Pancreas Transplantation: Summary of the International Pancreas and Islet Transplantation Association Pre-Congress Meeting

Originally exclusively considered for patients with type 1 diabetes, expansion of combined pancreas and kidney transplantation to select patients with type 2 diabetes (T2DM) has become more common internationally. It has become clear that the pancreas transplant community is grappling with a definition of "type 2 diabetes" in this context. Specifically, it is imperative that a definition be established to communicate uniformly and consistently about these patient populations as we develop policies, study outcomes, and compare pancreas transplantation to alternative therapies. As the pancreas transplant physicians and endocrinologists strive to characterize various forms of diabetes, the field seeks to identify the potential candidates among those with features of T2DM, and other forms of diabetes who can safely undergo pancreas transplantation and who would benefit from this procedure and be rendered normoglycemic, as is the expectation for successful pancreas transplantation in recipients with type 1 diabetes. To this end, the International Pancreas and Islet Transplantation Association Pancreas Transplant Interest Group organized a pre-Congress meeting before the 20th World Congress, held in Pisa, Italy, in the summer of 2025, titled "Definition and listing guidelines for pancreas transplantation in type 2 diabetes mellitus: don't hype the type." An international panel was invited to present on several topics related to the definition of T2DM in the context of pancreas transplantation. This review summarizes the presentations and follow-up discussion regarding pancreas transplantation for T2DM from the meeting.