[Simultaneous transplantation of the pancreas and kidney in terminal diabetic nephropathies]

Transplantation of the pancreas in late stages of type I diabetes has been performed increasingly frequently during recent years. By improved surgical techniques and immunsuppressive therapy including cyclosporin A, the 1-year graft function has increased to 60-70% and the patient survival to 85-95% in the institutions with greatest experience. These results are so good, that they nearly reach those from kidney transplantation. Most of the pancreas transplantations have been performed simultaneously with kidney transplantation in patients with end stage diabetic uremia. The results should therefore be evaluated according to these circumstances. In a few institutions transplantation of the pancreas is now performed in patients with persistent proteinuria and proliferative retinopathy in an attempt to avoid development of severe diabetic complications. The first pancreas transplantation in Denmark was performed Januar 31 st 1987, and since then, 17 further transplantations have been performed. All patients had severe diabetic nephropathy and received simultaneous kidney transplantation. According to the Danish heart death criteria the organs were perfused and cooled during the donor operation to keep the warm ischemia as brief as possible. The pancreatic vessels are anastomosed to the iliac vessels. In one group of patients the exocrine pancreatic function was preserved by anastomosis to the jejunum, and in another group of patients the exocrine function was abolished by injection of latex into the pancreatic duct system. The patients receive immunosuppression therapy with methylprednisolone, azatioprine and ciclosporin A and anti-coagulation therapy.