Effective in patients with Type I diabetes with autonomic insufficiency, labile blood sugar control, postural hypotension, diarrhea and gastroparesis.
The aim of pancreatic transplantation is to restore normoglycemia, cure diabetes, and limit the progression of complications associated with the disease.
The majority of cases are performed in individuals with type one diabetes that have end-stage renal disease, usually with uremic symptoms, retinopathy, progressive neuropathy, and hypoglycemic unawareness.
Not classified as a life saving procedure, but may significantly improve quality-of-life.
The potential to reverse diabetes is balanced against the morbidity of long term immunosuppressive agents associated with transplantation.
In patients with renal failure the treatment of choice is often a simultaneous transplant of the pancreas and kidney or pancreas after kidney transplant.
Five types of endocrine replacement using a pancreatic transplant: 1) pancreas transplant alone primarily for type one diabetics with frequent hypoglycemic episodes, noncompliance with insulin therapy. These patients frequently have adequate renal function and no uremia.2) simultaneous pancreas and kidney transplant. Includes type one diabetics with end-stage renal failure 3) pancreas after the kidney transplant indicated in those patients who would qualify for pancreas transplant alone, those with previously viable kidney allograft. Benefits include reduce waiting time and reduced mortality rate when compared with simultaneous pancreas kidney transplant4) simultaneous deceased donor pancreas and live donor kidney transplant has the benefit of lower rate of delayed graftfunction than simultaneous pancreatic kidney transplant and significantly reduces waiting times, resulting in improved outcomes compared with patient waiting for simultaneous pancreatic and kidney transplant5) islet cell transplant spider optimal insulin therapy
Diabetic motor, sensory and autonomic neuropathy are stabilized after transplantation.
10 years after normalization of glucose by pancreatic transplantation basement membrane and mesangial changes are demonstrated in kidney biopsies.
Results in stabilization of diabetic macrovascular changes.
About 400-500 performed each year in the U.S.
1-year survival rates range from 95-98%.
1-year graft survival rate is 78%.
Pancreas alone transplantation has a higher rejection rate than simultaneous pancreas and kidney transplantation (graft survival rate of 83% at 1 year) or pancreas after kidney transplantation graft survival rate of 79% at 1 year).
Thrombosis of graft’s artery or vein result in loss of 5-10% of pancreatic transplants.
10 year graft survival rates remain less than 50% with 40% failures related to technical complications and 15% due to acute rejection (Waki).
Most consider this procedure only when end-stage renal disease is present or impending.