LIVING-RELATED DONOR PANCREAS AND PANCREAS-KIDNEY TRANSPLANTATION

Our experience with living related donor (LRD) pancreas transplants sh ows that they can be performed with low morbidity and mortality for bo th donors and recipients. The recipient survival rate is 90% at both 1 and 5 years post-transplant. Our overall pancreas graft survival rate is comparable to that for cadaver transplants; if only technically su ccessful cases are included, the graft survival rate is significantly better for LRD (versus cadaver) transplants. Advantages for LRD recipi ents include fewer rejection episodes, less immunosuppression, lower i ncidence of graft loss from rejection, and elimination of waiting time . Donor mortality in our series was 0%, and the incidence of surgical complications about 10-15%. LRD pancreas transplants are on attractive option for endocrine replacement therapy in certain diabetic patients . Optimal candidates are: (i) patients who are highly sensitized and h ave a low probability of receiving a cadaver graft; (ii) patients who should avoid high-dose immunosuppression; (iii) patients with nondiabe tic identical twins; and (iv) uremic patients who want one operation w ith no waiting in order to remain or become dialysis free as well as i nsulin-independent. These transplants can be performed safely in all r ecipient categories-pancreas transplant alone, pancreas after kidney o r simultaneous pancreas-kidney transplant. In all groups, LRD transpla nts should be done only when the donor, the recipient, and the entire family understands the advantages and disadvantages of LRD versus cada ver transplants.