Pancreas transplantation: review

Area of Science:

• Transplantation immunology
• Endocrinology
• Surgical innovation

Background:

• Vascularized pancreas transplantation is the sole treatment for normalizing glucose and glycosylated hemoglobin in type 1 diabetes.
• Historical milestones include the first transplants in 1966 (USA) and 1968 (Brazil).
• Widespread adoption increased significantly after 1994 due to advancements like tacrolimus and mycophenolate mofetil.

Purpose of the Study:

• To review the history and outcomes of pancreas transplantation.
• To highlight the impact of immunosuppressive therapy on transplant success.
• To compare graft survival rates across different transplant types and patient populations.

Main Methods:

• Review of historical data and transplant registries, including the International Pancreas Transplant Registry.
• Analysis of patient and graft survival rates.
• Evaluation of complication rates and immunological loss.

Main Results:

• Over 35,000 pancreas transplants performed by 2010.
• One-year patient and graft survival rates exceed 95% and 83%, respectively.
• Simultaneous pancreas-kidney transplants show superior graft survival (pancreatic 86%, renal 93%) compared to pancreas-alone transplants (6% first-year immunological loss).
• Surgical complications requiring laparotomy occur in 10-20% of cases.

Conclusions:

• Pancreas transplantation significantly enhances the quality of life and survival for uremic diabetic patients.
• It offers a superior alternative to dialysis or kidney transplantation alone for this population.
• Despite surgical risks, the benefits of pancreas transplantation in managing type 1 diabetes are substantial.