PANCREAS TRANSPLANTATION FOR DIABETES-MELLITUS

Pancreas transplantation has become a viable option for the patient wi th insulin-dependent diabetes mellitus with progressive renal failure. The most common type of pancreas transplantation is a simultaneous pa ncreas and kidney transplantation performed from a single cadaver dono r (SPK). The next most common is pancreas transplantation after succes sful kidney transplantation (PAK). A few centers are performing pancre as transplantation alone (PTA) in diabetic recipients without renal di sease but who have significant complications from their diabetes. Panc reas transplantation is associated with a higher morbidity than kidney transplantation alone. Most pancreas transplantation centers report a significant increase in acute rejection, which can lead to increased hospitalization and risk of opportunistic infection. In addition, the early era of pancreas transplantation was associated with significant surgical complications. However, with bladder drainage of the pancreas exocrine secretions, the surgical complication rate has decreased sig nificantly. Despite medical and surgical complications, the overall re sults for pancreas transplantation are excellent, with 1-year graft su rvival of 75% for SPK transplantations and 48% for PAK and PTA transpl ant recipients. The effects of a pancreas transplantation on the secon dary complications of diabetes have been studied extensively. Most stu dies have shown a modest improvement in secondary complications with t he exception of diabetic retinopathy. The major benefit of pancreas tr ansplantation appears to be enhanced quality of life for patients succ essfully transplanted. For these reasons, the Kidney-Pancreas Committe e of the American Society of Transplant Physicians believes the curren t results of pancreas-kidney transplantation justify its use as a vali d option for insulin-dependent diabetic transplant recipients. (C) 199 6 by the National Kidney Foundation, Inc.