Fifteen years' experience with pancreas transplantation with pancreaticoenterostomy

We report on 92 pancreas transplantations with exocrine diversion by pancreaticoenterostomy. All recipients suffered from long-term type I (insulin-dependent) diabetes. In most transplantations, cadaveric segmental grafts were used (n = 89). In a few patients, segmental grafts from related donors were used (n = 3), and in a few other patients, whole-organ cadaveric grafts were used (n = 4). There were 9 retransplantations. Most pancreas transplantations were performed in uremic diabetic patients in combination with a kidney transplantation (n = 58). In a few patients the pancreas transplantation was performed after a kidney transplantation (n = 6). The remaining transplantations were in nonuremic diabetic patients who received only a pancreas (n = 25). Over the years, the results have improved considerably; in the 1986-1987 series the overall 1-yr patient survival (ps) and graft survival (gs) rates were 97 and 56%, respectively. The best results were achieved with the combined procedure (ps 100%, gs 77%); with pancreas only, the figures were inferior (ps 92%, gs 34%). Several factors explain the improved results. The incidence of graft thrombosis has been reduced by the use of anticoagulation, and posttransplantation pancreatitis has been reduced by avoiding ischemic injury to the graft. Cyclosporin has helped reduce the incidence of graft rejection, and monitoring of the exteriorized pancreatic juice has helped in the diagnosis of rejection.