Improved results in pancreatic transplantation by avoidance of nonimmunological graft failures

Twenty eight consecutive combined renal and pancreatic transplantations with enteric exocrine diversion were performed between June 1984 and May 1986. The one-year actuarial patient survival and renal and pancreatic graft survival were 90%, 67%, and 69%, respectively. Nineteen pancreatic grafts and eighteen renal grafts are currently functioning at 1-24 months. Of the pancreatic graft losses only 2 were attributable to nonimmunological complications. No pancreatic graft was lost due to pancreaticoenteric leakage or vascular thrombosis. This was achieved by reducing the cold ischemia time and by adopting an aggressive anticoagulant policy. In all patients with functioning grafts the fasting blood glucose, glycosylated hemoglobin level, and oral glucose tolerance test were normal. The intravenous glucose tolerance test was normal in most of the patients but subnormal in some.