[Metabolic and immunologic sequelae of pancreas transplantation in the pig]

After induction of a Streptozotocin-induced diabetes mellitus solitary pancreas transplants were performed in 31 Yorkshire-Landrace pigs. Exocrine pancreatic secretions were bladder drained (duodenocystostomy). Postoperatively all animals were subject to a standardized immunosuppression. The purpose of the study was both to examine the intensity of rejection episodes within a certain time period and to correlate laboratory with histology data. Cystoscopic transduodenal pancreas biopsies in defined intervals were obtained by intraoperative ultrasound control; this technique reduces the complication rate and should be used clinically. The biopsy results showed that severe rejection episodes despite high dose triple-immunosuppression for induction therapy were noted histologically and immunohistochemically as early as postoperative day 6. Morphological changes significantly preceded functional changes. Due to the distinct immunogenicity of pancreas transplants and in order to decrease incidence and severity of rejection episodes, quadruple-immunosuppression (including T-cell-antibodies) is imperative for induction therapy and anti-rejection treatment. Our results demonstrate that solitary pancreas transplantation is clinically indicated only in patients with extremely labile diabetes mellitus due to the high immunosuppression required. This animal model should be utilized for further studies to improve the result of solitary pancreas transplantation.