Compared to the still increasing number of kidney, Liver and heart tra
nsplants performed worldwide, pancreas transplantation remains a rare
occurrence. At our center a pancreas transplant program was began in l
ate 1979. Since then a total of 113 pancreas transplants were performe
d in 106 patients, 100 of them also received a kidney from the same do
nor. The first group consisted of 5 patients with immediate duct occlu
sion (IDO). In the second group (n = 8) the pancreatic juice of the se
gmental graft was diverted into a Roux-Y loop of jejunum. Because of t
wo fatal technique-associated complications, delayed duct occlusion wa
s introduced and applied in 15 patients. Because of a prolonged hospit
alization period due to local complications, the surgical technique wa
s changed again. From 1987, 72 segmental pancreatic transplants with b
ladder drainage were performed and finally one whole organ with a duod
enal segment was transplanted. Immunosuppression consisted of cyclospo
rine A, azathioprine and prednisolone from 1984 on. Rejection episodes
were treated with high-dose methylprednisolone on 3 consecutive days
and steroid-resistant rejections with ATG. The overall patient surviva
l at 6 years was 80%, renal allograft survival 72% and pancreas graft
survival 63% for the entire group. In the delayed duct occlusion group
, 1-year patient and kidney graft survival of 93% each and 79% for the
pancreas was calculated. One-year survival in the most recent and lar
gest group with bladder drainage was 89% for patients, 86% for the kid
ney and 75% for the pancreas. Excellent metabolic control was achieved
in the majority of patients with mean C-peptide levels and HbA1C leve
ls at 6 months of 1.46 pmol/ml and 5.6%, respectively. Successful panc
reas transplants with normalization of carbohydrate metabolism Immunos
uppression seem to have a beneficial effect on secondary complications
of diabetes, contributing to the high degree of rehabilitation of the
se patients.