METABOLIC AND IMMUNOLOGICAL CONSEQUENCES OF PANCREAS TRANSPLANTATION IN PIGS

After induction of a Streptozotocin-induced diabetes mellitus solitary pancreas transplants were performed in 31 Yorkshire-Landrace pigs. Ex ocrine pancreatic secretions were bladder drained (duodenocystostomy). Postoperatively all animals were subject to a standardized immunosupp ression. The purpose of the study was both to examine the intensity of rejection episodes within a certain time period and to correlate labo ratory with histology data. Cystoscopic transduodenal pancreas biopsie s in defined intervals were obtained by intraoperative ultrasound cont rol; this technique reduces the complication rate and should be used c linically. The biopsy results showed that severe rejection episodes de spite high dose triple-immunosuppression for induction therapy were no ted histologically and immunohistochemically as early as postoperative day 6. Morphological changes significantly preceded functional change s. Due to the distinct immunogenicity of pancreas transplants and in o rder to decrease incidence and severity of rejection episodes, quadrup le-immunosuppression (including T-cell-antibodies) is imperative for i nduction therapy and anti-rejection treatment. Our results demonstrate that solitary pancreas transplantation is clinically indicated only i n patients with extremely labile diabetes mellitus due to the high imm unosuppression required. This animal model should be utilized for furt her studies to improve the result of solitary pancreas transplantation .