OBJECTIVE - To determine the safety and efficacy of solitary pancreas
transplantation in the treatment of IDDM. RESEARCH DESIGN AND METHODS
- A single-center retrospective case series of 62 consecutive solitary
pancreas transplants (20 sequential pancreas after kidney, 42 pancrea
s transplants alone) performed in 57 adult IDDM patients was studied.
Indications for solitary pancreas transplantation were I) the presence
of two Or more overt diabetic complications and/or 2) glucose hyperla
bility with hypoglycemic unawareness and impaired quality of life. The
recipient group consisted of 31 men and 26 women with a mean age of 3
8 years (range 25-62) and a mean duration of diabetes of 26 years (ran
ge 14-52). Mean pretransplant glycohemoglobin level was 9.9 +/- 2.6%.
Organ acceptance was restricted to ideal donors and mandated a minimum
of a two-antigen match (mean human leukocyte antigen ABDR match 2.7).
The mean told ischemia time was 16.6 h. Whole-organ pancreas transpla
ntation was performed with bladder drainage by the duodenal segment te
chnique. All patients mere managed with either triple or quadruple imm
unosuppression. Monitoring included prospective urine cytology as well
as cystoscopic transduodenal needle biopsies. RESULTS - The mean leng
th of initial hospital stay was 18 days, and mean hospital charges wer
e $106,341. The incidences of rejection, infection, and surgical compl
ications were 70, 55, and 47%, respectively. Overall patient and graft
survival rates were 86 and 52%, respectively with a mean follow-up of
28 months. All patients with functioning grafts had excellent metabol
ic control (mean glycohemoglobin level 5.1%) and achieved good rehabil
itation. CONCLUSIONS - Despite morbidity, solitary pancreas transplant
ation can be performed with improving success, can enhance quality of
life, and can offer an opportunity to arrest secondary diabetic compli
cations.