Pancreas Transplantation: For whom and when

Overview

Hyperglycemia is an important factor in the development and progression of the complications of diabetes. Pancreastransplantation is currently the only method able to achieve sustained normoglycemia in type I diabetes. By now,this procedure has become an accepted treatment option combined with kidney transplantation for selected patientswith end-stage diabetic nephropathy. The definite benefits of pancreas transplantation comprise relieve from insulinadministration, superb glycemic control, improved quality of life and long-term survival of patient with severeautonomic neuropathy. Presumed benefits represent stabilization or slowing of progression of microvascularcomplications. Definite disadvantages are the risk of the surgical procedure, graft rejection and the necessity ofpermanent immunosuppression. Isolated pancreas transplantation in nonuremic type-1 diabetic patients is stillcontroversial. Diabetic complications of the potential recipient have to be potentially correctable by the transplantationand their significance must exceed all risks of the operation and life-long immunosuppression. Currently, approx.25 combined transplants are performed per year in IKEM with the results comparable to those reported by theInternational Pancreas Transplant Registry. Seven nonuremic type-1 diabetic recipients of 8 operated in IKEM byJune 2000 have been insulin-independent for 1–33 months. The main indication for isolated pancreas transplantationis brittle diabetes with hypoglycemia unawareness syndrome and labile diabetes with severe autonomic neuropathyand rapid progression of microangiopathy despite appropriate intensified insulin therapy.?

Key words:
diabetes mellitus, pancreas transplantation, diabetic nephropathy, microangiopathy.