Pancreas organ transplantation - Short and long-term results in terms of diabetes control

Diabetes mellitus is a very common and dreadful disease which cannot be cur ed by exogenous insulin substitution. Many of the patients suffer from recu rrent, and sometimes rather dangerous, hypo- or hyperglycemias and, in the long term, from the well-known secondary diabetic complications. At the mom ent, pancreas transplantation is the only known therapy to reliably reestab lish endogenous insulin secretion responsive to normal feed back controls. Within the last decade, pancreas transplantation has evolved as a clinicall y well-established procedure. Nevertheless, the perioperative risk after pa ncreas/kidney transplantation is still higher than after isolated kidney tr ansplantation. However, the benefits of a functioning pancreas graft for th e patients are enormous. Ten-year survival of type-I diabetic patients with combined pancreas/kidney grafts is dramatically better than of those with an isolated kidney graft. Long-term function of the pancreas grafts is exce llent, reaching more than 60% after 10 years. Contrary to kidney transplantation, chronic rejection does not seem to be a major problem. Blood glucose levels in the fasting state, after glucose ch allenge, and in the postprandial state are completely normalized. A signifi cant peripheral hyperinsulinemia, however, is found when the pancreas graft is connected to the systemic venous circulation. Thus, portal venous drain age of the pancreas graft, which is already being per formed by a few trans plant centers routinely, might be the procedure of choice for the future. B eneficial effects on secondary diabetic lesions can only be expected after a rather long observation period. In addition, for all secondary diabetic c omplications, there is a point of no return. Nevertheless, significant impr ovement of diabetic polyneuropathy, diabetic nephropathy, and the disturbed microcirculation has been convincingly demonstrated. The effect on diabeti c retinopathy, however, is still controversial. One of the most impressive effects for the pancreas graft recipients seems to be the enormous improvem ent in quality of life, which is reported unanimously by almost all patient s. Thus, simultaneous pancreas/kidney transplantation can be regarded as th e optimal and only causal therapy for type-I diabetic patients with end-sta ge renal disease.