THE ROLE OF WHOLE-ORGAN PANCREAS TRANSPLANTATION IN THE TREATMENT OF TYPE-I DIABETES

BACKGROUND AND DEMOGRAPHICS: Clinical course was reviewed for 19 whole organ pancreas transplant recipients at UCLA between 11/14/93 and 5/3 1/95, 18 of which were simultaneous pancreas kidney transplants and I of which was an isolated pancreas after kidney transplant. The initial 4 pancreatic grafts were procured by classical warm dissection techni ques while the remaining 15 were procured by rapid en bloc technique, Mean recipient age, duration of diabetes, and daily insulin requiremen ts were 38 years, 25 years, and 45 units, respectively. Bladder draina ge of exocrine secretions was used primarily in 18 cases and primary e nteric drainage in one. RESULTS: All recipients manifested immediate d ialysis and insulin independence, Actuarial patient and graft survival were 100% and 89%, respectively, at a mean follow-up of 396 days (ran ge, 150-660 days). Mean maximal serum amylase on the first postoperati ve day was 366 U/dL. There were no instances of pancreatic graft vascu lar thrombosis, Three patients experienced pancreatic leaks (16%), 1 o f which resulted in graft loss. Six month posttransplant Hgb A1c was w ithin normal range and significantly lower than pretransplantation val ues (5.1 vs 10.7, P = 0.002). Mean length of initial hospitalization w as 15 days, with 100% of patients requiring at least one readmission. Fifty-eight percent of patients experienced rejection episodes, Ninety -one percent of patients responding to a quality of life survey report ed improvement in general sense of well-being after transplantation. C ONCLUSIONS: It is concluded that high rates of success may be possible with whole organ pancreas transplantation, even in new programs, Rapi d en bloc dissection is a safe, expeditious method of pancreas procure ment. Successful pancreatic transplantation is associated with freedom from exogenous insulin administration, normalization of glycated hemo globin, and subjective improvement in quality of life. However, this m odality is associated with higher rates of rejection and readmission, and longer duration of hospitalization when compared with isolated kid ney transplantation.