Pancreatic transplantation in diabetes mellitus: present status

Between December 1966 and June 1982, 269 transplantations of vascularized pancreas (whole or segmental) were undertaken in 254 diabetic patients throughout the world. Most of the transplantations were performed in patients with end-stage renal disease who also received kidney grafts; a few patients received pancreatic grafts only. About 25% of the pancreatic grafts are still functioning after periods of various lengths, the longest being five years. To the problem of how to handle the exocrine secretion there are two main approaches: 1) occlusion of the duct with a synthetic polymer and 2) pancreatico-enterostomy. A disadvantage of the former procedure is late fibrosis and atrophy of the endocrine tissue. With the latter method duct leakage and fistula development cannot be completely prevented. In either case, vascular complications cause graft failure in about 20% of the operations. The risk of rejection of the graft seems not to differ significantly from that concerning other allogeneic organs, including the kidney and heart. Most of the patients with a functioning pancreatic graft are normoglycemic: they have a normal or near-normal oral or intravenous glucose tolerance and an early insulin response to intravenous glucose tolerance and an early insulin response to intravenous glucose challenge. Whether the improvement of the motor and sensory nerve conduction velocities observed in some patients whose graft has functioned for a long time is due to the reversal of renal insufficiency or to insulin deficiency cannot yet be determined. At present, pancreas transplantation at Huddinge Hospital is performed only in conjunction with renal transplantation in patients with end-stage diabetic renal disease.(ABSTRACT TRUNCATED AT 250 WORDS)