Current concepts in pancreas transplantation

Increasing prevalence of insulin-dependent diabetes in associated with a rise in organ complications, markedly increasing morbidity and mortality, especially those of young and middle-aged people. The key role in the etiopathogenesis of diabetic nephropathy, retinopathy and neuropathy is played by a metabolic disorder. The only procedure capable of restoring normal metabolism is replacement of damaged endocrine tissue, i.e., pancreas transplantation. A look back into the history, and a review of current concepts in experimental and clinical pancreases transplantation, highlight some questions to be solved, yet including prevention of the adverse effect of pancreatic hydrolytic enzymes, inhibition of the onset of thrombosis, and timely diagnosis of rejection. The currently employed techniques--pancreatic duct obliteration with polymer, intestinal and urinary bladder drainage of pancreatic secretion--yield approximately similar results. The technique of pancreas transplantation has not been refined to such an extent so as to enable its performance in the early stage of diabetes in a effort to prevent the onset of complications. Patients deriving most benefit from the technique are mainly uremic diabetics undergoing it in combination with renal transplantation which yields optimal results. While a renal graft allows improved detection of pancreas rejection, a pancreatic graft confers protection against recurrence of diabetic nephropathy. Simultaneous transplantation of both organs represents not only a life-saving procedure, it also offers appreciable improvement of the quality of life of the diabetic patient.