Pancreas Transplantation

Abstract Pancreas transplantation is a surgical treatment for complicated cases of diabetes mellitus type 1 and occasionally type 2. Patients with a history of frequent, severe metabolic complications (marked hypoglycemia or hyperglycemia, ketoacidosis) and failing insulin management are typical candidates. The procedure was first performed in humans in 1966. Now, due to development of better immunosuppressive agents (specifically cyclosporine and anti–T-cell antibodies), advanced surgical techniques, and better patient selection, more than 700 of various types of pancreatic transplants are performed yearly in the United States alone. Most patients receive a pancreas from a cadaver donor, but donation by a living related donor is also possible. The goals of transplantation are to restore glucose-regulated endogenous insulin secretion, arrest the progression of the complications of diabetes, and improve quality of life. There are several types of such treatment as follows: pancreas transplant alone (PTA), simultaneous pancreas-kidney transplant (SPK), pancreas after kidney transplant (PAK), and islet transplant (developing technology). SPK is the most common type of transplant, which is performed on patients with diabetes type 1 complicated by end-stage renal disease. Complications following pancreas transplant occur more frequently than in other abdominal solid organ transplants. Although major complications following pancreas transplant are uncommon, several, including pancreatitis, exocrine duct leaks, and pancreatic pseudocysts, are unique to this transplant. The most common reason for graft failure overall is immunologic rejection. Both pancreas and islet transplantation require lifelong immunosuppression to prevent rejection of the graft.