Title: Pancreas transplantation — Indications and outcomes
Abstract: Background: Pancreas transplantation is the only treatment of Type I diabetes that establishes an insulin-independent, constant normoglycemic state. The penalty for this benefit is the need for immunosuppression in the recipients. Thus, most pancreas transplants are performed in patients with advanced diabetic nephropathy who receive kidney transplants to treat uremia, and who are obligated to immunosuppression for this reason. Methods: Of the 4,000 pancreas transplants reported to the International Pancreas Transplant Registry from 1966 and 1992, approximately 85% were in diabetic renal allograft recipients. Pancreas transplants alone are primarily performed in highly selected patients with extremely labile diabetes. Results: Since 1986, success rates (insulin-independence for ≥ 1 year), as calculated by the Pancreas Transplant Registry, have been approximately 75% for pancreas transplants performed simultaneous with a kidney, and approximately 50% when performed as a solitary procedure. Studies of the effect of pancreas transplantation on secondary complications of diabetes have been mixed. Clinical neuropathy and early, but not advanced, nephropathy are favorably influenced, while advanced retinopathy is not. Several studies show a favorable impact on how recipients rate their quality of life post-pancreas transplant. Conclusion: Pancreas transplantation has evolved into a very routine method of beta cell replacement in many centers when performed in conjunction with renal allografts for treatment of uremia. As a solitary procedure, it has a role in the treatment of highly selected patients with extremely labile diabetes not well served by the alternatives. Ultimately, pancreas transplantation will probably be superseded by islet transplantation. For the moment, however, only pancreas transplantation can be offered with a probability of success approaching, or similar to, that of other solid organ transplants.
Publication Year: 1994
Publication Date: 1994-01-01
Language: en
Type: article
Indexed In: ['crossref']
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Cited By Count: 1
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