Pancreas Transplantation

Summary

In summary, solitary pancreas transplants (alone in non-uremics—PTA; or after a kidney—PAK) should be done, as well as simultaneous pancreas-kidney (SPK) transplants in uremic diabetics who cannot get a kidney transplant first (to preempt or shorten the time on dialysis). The approach depends on the recipient candidate characteristics and on living or deceased donor availability and suitability. It is regressive to restrict pancreas transplants to just the uremic population, and in this restricted population to just those who cannot get an early kidney transplant to preempt the dialysis that would otherwise be necessary while waiting for both organs from a deceased donor. For the uremic diabetic in centers where there is a long wait time for a deceased donor SPK transplants (because of kidney allocation policies), the best option is a living donor kidney followed by a pancreas transplant; a living donor eliminates waiting for a kidney, and the waiting time for a solitary pancreas at present is relatively short. The patient survival rates are high after either PTA, PAK or SPK transplants, at 3 years 93%;, 90% and 91% respectively, with corresponding graft survival (insulin-independence) rates of 60%, 66% and 78%, respectively. Even though pancreas graft survival rates are higher after SPK transplants, the gain in patient survival rates by doing a preemptive kidney transplant more than offsets the lower insulin-independence rates after a PAK. The outcomes justify the continuance of pancreas transplants in all three categories of recipients, with nearly all nephropathic diabetics being PAK or SPK candidates (since immunosuppression will be obligatory for a kidney transplant), and selected non-uremic diabetics, particularly those with hypoglycemic unawareness, being candidates for a PTA.