Pancreas and Islet Transplant Population

  • David E. R. Sutherland


This chapter describes algorithms for diabetic candidate selection for β-cell replacement therapy (by recipient category) and algorithms for donor allocation. The algorithms are based on a 35-year experience with β-cell replacement at the University of Minnesota as well as on the experience of others, as garnered from the scientific literature or from personal discussions with leaders in the field.


Islet Transplant Pancreas Transplant Exocrine Deficiency Hypoglycemic Unawareness Pancreas Transplant Alone 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Herring BJ, Kandaswamy R, Harmon JV, et al. Insulin independence after single-donor islet transplantation in type 1 diabetes with hOKT3gamma-1(ala-ala), sirolimus, and tacrolimus therapy. Am J Transplant 2001; 1 (suppl. 1): 180.Google Scholar
  2. 2.
    Sutherland DER, Gruessner RWG, Dunn DL, et al. Lessons learned from more than 1000 pancreas transplants at a single institution. Ann Surg 2001; 233: 463–501.PubMedCrossRefGoogle Scholar
  3. 3.
    Sasaki TM, Gray RS, Retner RE, et al. Six successful long-term kidney pancreas transplants in diabetic patients with high C-peptide levels. Transplantation 1999; 67: 568A.Google Scholar
  4. 4.
    Light J, Sasaki TM, Currier CB, et al. Successful long-term kidney-pancreas transplants regardless of C-peptide status or race Transplantation 2001; 71: 152–154.PubMedGoogle Scholar
  5. 5.
    Sutherland DER. Is immunosuppression justified for nonuremic, diabetic patients to keep them insulin-independent? (Argument for). Transplant Proc 2002; 34: 1927–1928.PubMedCrossRefGoogle Scholar
  6. 6.
    Cryer PE. Hypoglycemia-associated autonomic failure in diabetes. Am J Physiol Endocrinol Metab 2001; 281: E1115 - E1121.PubMedGoogle Scholar
  7. 7.
    Diabetes Control and Complications Trial Research Group. (DCCT): The effects of intensive diabetes treatment and longterm complications in IDDM. N Engl J Med 1993; 329: 977–986.Google Scholar
  8. 8.
    Diabetes Control and Complications Trial Research Group. Hypoglycemia in the Diabetes Control and Complications Trial. Diabetes 1997; 46: 271–286.CrossRefGoogle Scholar
  9. 9.
    Gruessner A, Sutherland DER. Analysis of United States (U.S.) and non-U.S. pancreas transplants reported to the United Network for Organ Sharing and the International Pancreas Transplant Registry as of October 2001. In: Ceka M, Terasaki PI, eds. Clinical Transplantation-2001. Los Angeles: University of California at Los Angeles Press; 2002: 41–72.Google Scholar
  10. 10.
    Benedetti E, Dunn T, Massad MG, et al. Successful living related simultaneous pancreas-kidney transplants between identical twins. Transplantation 1999; 67: 915–918.PubMedCrossRefGoogle Scholar
  11. 11.
    Sutherland DER, Gores PF, Farney AC, et al. Evolution of kidney, pancreas and islet transplantation for patients with diabetes at the University of Minnesota. Am J Surg 1993; 66: 456491.Google Scholar
  12. 12.
    Gruessner RWG, Sutherland DER. Simultaneous kidney and segmental pancreas transplants from living related donors. Transplantation 1996; 61: 1265–1268.PubMedCrossRefGoogle Scholar
  13. 13.
    Gruessner RWG, Sutherland DER, Drangstveit MB, et al. Pancreas transplants from living donors: Short-and long-term outcome. Transplant Proc 2001; 33: 819–820.PubMedCrossRefGoogle Scholar
  14. 14.
    Farney AC, Choe E, Schweitzer E, et al. Simultaneous cadaver pancreas living donor kidney transplantation (SPLK). Ann Surg 2000; 232: 646–703.CrossRefGoogle Scholar
  15. 15.
    Lane JT, Ratanasuwan T, Mack-Shipman LR, et al. Cyclosporine challenge test revisited: Does it predict outcomes after solitary pancreas transplantation? Clin Transplant 2001; 15: 28–31.PubMedCrossRefGoogle Scholar
  16. 16.
    Fioretto P, Steffes MW, Sutherland DER, et al. Reversal of lesions of diabetic nephropathy after pancreas transplantation. N Engl J Med 1998; 339: 69–75.PubMedCrossRefGoogle Scholar
  17. 17.
    Personal observations of the author.Google Scholar
  18. 18.
    Gold AE, MacLeod KM, Frier BM. Frequency of severe hypoglycemia in patients with type 1 diabetes with impaired awareness of hypoglycemia. Diabetes Care 1993; 17: 697–703.CrossRefGoogle Scholar
  19. 19.
    United Network for Organ Sharing (UNOS). 2001 Annual Report of the U.S. Scientific Registry of Transplant Recipients and the Organ Procurement and Transplantation Network. Washington DC: US Department of Health and Human Services; 2000.Google Scholar
  20. 20.
    Sutherland DER, Morrell P, Gruessner RWG. Transplantation of two diabetic patients with one divided cadaver donor pancreas. Transplant Proc 1990; 22: 585–586.PubMedGoogle Scholar
  21. 21.
    Shapiro AM, Lakey JR, Ryan EA, et al. Islet transplantation in seven patients with type 1 diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. N Engl J Med 2000; 343: 230–238.PubMedCrossRefGoogle Scholar
  22. 22.
    Sutherland DER, Goetz FC, Najarian JS. Living-related donor segmental pancreatectomy for transplantation. Transplant Proc 1980; 12: 19–25.PubMedGoogle Scholar
  23. 23.
    Sutherland DER, Matas AJ, Najarian JS. Pancreatic islet cell transplantation. Surg Clin North Am 1978; 58: 365–382.PubMedGoogle Scholar
  24. 24.
    Najarian JS, Sutherland DER, Baumgartner D, et al. Total or near-total pancreatectomy and islet autotransplantation for treatment of chronic pancreatitis. Ann Surg 1980; 192: 526–542.PubMedCrossRefGoogle Scholar
  25. 25.
    Farney AC, Najarian JS, Nakhleh RE, et al. Autotransplantation of dispersed pancreatic islet tissue combined with total or near-total pancreatectomy for treatment of chronic pancreatitis. Surgery 1991; 110: 427–439.PubMedGoogle Scholar
  26. 26.
    Wahoff DC, Papalois BE, Najarian JS, et al. Autologous islet transplantation to prevent diabetes after pancreatic resection. Ann Surg 1995; 22: 562–579.Google Scholar
  27. 27.
    Robertson RP, Lanz KJ, Sutherland DER, et al. Prevention of diabetes for up to 13 year by autoislet transplantation after pancreatectomy for chronic pancreatitis. Diabetes 2001; 50: 47–50.PubMedCrossRefGoogle Scholar
  28. 28.
    Pratschke J, Wilhelm MJ, Kusaka M, et al. Brain death and its influence on donor organ quality and outcome after transplantation. Detrimental effect on organs procured for transplantation. Transplantation 1999; 67: 343–348.PubMedCrossRefGoogle Scholar
  29. 29.
    Emond JC, Whitington PF, Thistlewaite JR, et al. Transplantation of two patients with one liver: Analysis of a preliminary experience with “split liver” grafting. Ann Surg 1990; 212: 14–22.PubMedCrossRefGoogle Scholar
  30. 30.
    Gruessner RWG, Kandaswamy R, Denny R. Laparoscopic simultaneous nephrectomy and distal pancreatectomy from a live donor. J Am Coll Surg 2001; 193: 333–337.PubMedCrossRefGoogle Scholar
  31. 31.
    Krolewski AS, Warram JH, Freire MB. Epidemiology of late diabetic complications. A basis for the development and evaluation of preventive programs. Endocrinol Metab Clin North Am 1996; 25: 217–242.PubMedCrossRefGoogle Scholar
  32. 32.
    Syndman D. Infection in solid organ transplantation. Transplant Infect Dis 1999; 1: 21–28.CrossRefGoogle Scholar
  33. 33.
    Humar A, Uknis M, Carlone-Jambor C, et al. Cytomegalovirus disease recurrence after ganciclovir treatment in kidney and kidney-pancreas transplant recipients. Transplantation 1999; 67: 94–97.PubMedCrossRefGoogle Scholar
  34. 34.
    Matas AJ, Humar A, Payne WD, et al. Decreased acute rejection in kidney transplant recipients is associated with decreased chronic rejection. Ann Surg 1999; 230: 493–500.PubMedCrossRefGoogle Scholar
  35. 35.
    Sutherland DER, Gruessner RG, Humar A, et al. Pre-transplant immunosuppression for pancreas transplants alone in non-uremic diabetic recipients. Transplant Proc 2001; 33: 1656–1658.PubMedCrossRefGoogle Scholar
  36. 36.
    Squifflet JP, Sutherland DER, Morrow CE, et al. The post-operative course and quantitative aspects of rat islet and segmental pancreas isografts. J Surg Res 1984; 36: 578–587.PubMedCrossRefGoogle Scholar
  37. 37.
    Navarro X, Kennedy WR, Aeppli D, et al. Neuropathy and mortality in diabetes: Influence of pancreas transplantation. Muscle Nerve 1996; 19: 1009–1016.PubMedCrossRefGoogle Scholar
  38. 38.
    Kandaswamy R, Ramcharan T, Matas A, et al. Kidney and kidney-pancreas tranplants in Jehovah’s Witnesses-a single-center experience with 50 transplants. Acta Chir Austriaca 2001; 33 (suppl 174): 3.Google Scholar
  39. 39.
    Kuo PC, Stock PG. Transplantation in HIV positive patients. Am J Transplant 2001; 1: 13–17.PubMedCrossRefGoogle Scholar
  40. 40.
    Stempl CA, Lake J, Kuo G, et al. Hepatitis C-its prevalence in end-stage renal failure patients and clinical course after kidney transplantation. Transplantation 1993; 55: 273–276.CrossRefGoogle Scholar
  41. 41.
    Manske CL, Wang Y, Rector T, et al. Coronary re-vascularization in insulin-dependent diabetic patients with chronic renal failure. Lancet 1992; 340: 998–1002.PubMedCrossRefGoogle Scholar
  42. 42.
    Bendel-Stenzel MR, Kashtan CE, Sutherland DER, et al. Simultaneous pancreas-kidney transplant in two children with hemolytic-uremic symptoms. Pediatr Nephrol 1997; 11: 485–487.PubMedCrossRefGoogle Scholar
  43. 43.
    Gruessner RWG, Manivel DC, Dunn DL, et al. Pancreaticoduodenal transplantation with enteric drainage following native total pancreatectomy for chronic pancreatitis. Pancreas 1991; 6: 479–488.PubMedCrossRefGoogle Scholar
  44. 44.
    Stem RC, Mayes JT, Weber FL, et al. Restoration of exocrine pancreatic function following pancreas-liver-kidney transplantation in a cystic fibrosis patient. Clin Transplant 1994; 8: 1–4.Google Scholar
  45. 45.
    Tyden G, Bolinder J, Solders G, et al. Improved survival in patients with insulin-dependent diabetes mellitus and end-stage diabetic nephropathy 10 years after combined pancreas and kidney transplantation. Transplantation 1999; 67: 645–648.PubMedCrossRefGoogle Scholar
  46. 46.
    Smets YF, Westendrop RG, van der Pill JW, et al. Effect of simultaneous pancreas-kidney transplantation on mortality of patients with type 1 diabetes mellitus and end-stage renal failure. Lancet 1999; 353: 1915–1919.PubMedCrossRefGoogle Scholar
  47. 47.
    Becker BN, Bvrazy PC, Becker YT, et al. Simultaneous pancreas-kidney transplantation reduces excess mortality of type 1 diabetic patients with end-stage renal disease. Kidney Int 2000; 57: 2129–2135.PubMedCrossRefGoogle Scholar
  48. 48.
    Rayhill SC, D’Alessandro AM, Odorico JS, et al. Simultaneous pancreas-kidney transplantation and living related donor renal transplantation in patients with diabetes: Is there a difference in survival? Ann Surg 2000; 231: 417–423.PubMedCrossRefGoogle Scholar
  49. 49.
    Gruessner AC, Sutherland DER, Dunn DL, et al. Pancreas after kidney transplants in post-uremic patients with type 1 diabetes mellitus. J Am Soc Nephrol 2001; 12: 2490–2499.PubMedGoogle Scholar
  50. 50.
    Gross CR, Limwattananon C, Matthees BJ, et al. Quality of life after pancreas transplantation: A review. Clin Transplant 1998; 12: 351–361.PubMedGoogle Scholar
  51. 51.
    Humar A, Kandaswamy R, Gruessner RWG, et al. Chronic rejection in pancreas transplant recipients: A multivariate analysis of risk factors. Transplantation 2000; 69: 5410.Google Scholar

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© Springer Science+Business Media New York 2004

Authors and Affiliations

  • David E. R. Sutherland

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