Patient selection for pancreas transplantation

Pancreas transplantation is the only currently available potential cure for type I diabetes. Because of the complications of the procedure and the toxicity of immunosuppression, patients must be carefully selected. The procedure can be justified in patients who already require immunosuppression for a renal allograft. The benefits of improved quality of life and protection from the development of nephropathy in the kidney allograft are significant. Pancreas transplantation alone is harder to justify; the risks of immunosuppression would seem to outweigh the known benefits of normalization of blood glucose. Before pancreas transplantation gains wide acceptance, the graft survival rates must improve. Currently, pancreas graft survival rates are greater than 80% at 1 year, but less than 50% 5 years after the transplantation. Improvement in these rates may occur with the development of more effective and less toxic immunosuppressive agents. Continued improvement in surgical technique should also contribute to overall pancreas transplantation success. Until then, however, pancreas transplantation should be viewed as a therapy for only selected patients in whom the benefits clearly outweigh the risks.