EVOLUTION OF KIDNEY, PANCREAS, AND ISLET TRANSPLANTATION FOR PATIENTSWITH DIABETES AT THE UNIVERSITY-OF-MINNESOTA

Transplantation began at the University of Minnesota in 1963. Treatmen t of diabetes and its complications has been emphasized since 1966, wh en the first pancreas-kidney transplant was done. Of 3,640 kidneys tra nsplanted by 1992, 1,373 were for diabetic recipients, including 658 f rom living donors and 715 from cadaver donors. The results progressive ly improved; since 1984, survival rates of kidney grafts have been sim ilar for diabetic and nondiabetic recipients, with three fourths of th e grafts functioning at 4 years. As of 1992, 501 pancreas transplants had been done, including 170 simultaneous with a kidney, 142 after a k idney, and 188 alone for nonuremic diabetic patients; again, the resul ts have improved: by the l990s, graft survival rates were similar in t he 3 recipient categories. Successful pancreas transplants have been s hown by our coworkers to stabilize or improve neuropathy and prevent r ecurrence of diabetic nephropathy in kidney grafts. In an attempt to s implify endocrine replacement therapy, we have done 63 human islet tra nsplants, 34 as allografts for patients with type I diabetes and 29 as autografts after total pancreatectomy to treat chronic pancreatitis. Insulin independence occurs for about 50% of islet autograft recipient s. Two recent islet allograft recipients treated with 15-deoxyspergual in have had sustained insulin independence. We anticipate that endocri ne replacement therapy by transplantation will become routine for diab etic patients as methods to prevent rejection are refined.