EXPERIENCE WITH 49 SEGMENTAL PANCREAS TRANSPLANTS IN 45 DIABETIC PATIENTS

Abstract

Pancreas transplants (49) were performed in 45 patients between July 23, 1978-May 14, 1982, 18 from related donors. As of June 1982, 13 patients have functioning grafts and are insulin independent between 1-46 mo. after transplantation, 5 for more than 1 yr. Nineteen patients lost graft function between 1-7 mo. Sixteen grafts failed for technical reasons. Eight patients died between 1-21 mo. from infections or preexisting complications or for unknown reasons, 3 with functioning grafts. Actuarial 1-yr graft survival is 24% and patient survival is 84%. A variety of techniques were used to handle exocrine secretions of 41 hemipancreas segmental grafts, 4 extended segmental grafts and 4 whole pancreas grafts. Three of 14 duct-open, 0 of 2 duct-ligated, 0 of 4 prolamine-injected, 6 of 19 silicone rubber-injected and 4 of 10 jejunal anastomosed pancreatic grafts are functioning. Of 33 technically successful allografts, 5 in 12 conventionally immunosuppressed and 8 in 21 cyclosporin A (Cy A)-immunosuppressed recipients are functioning. Most technically successful grafts that failed were not biopsied or removed. In those that were biopsied, fibrosis was a dominant feature in all but 1 patient. In this patient endocrine and exocrine tissue, it was normal except for the absence of insulin-positive (.beta.) cells in the islets and an increase in glucagon-positive (.alpha.) cells, in contrast to the normal appearance of .alpha. and .beta. cells in islets at the time of the pancreas transplant. Pancreas transplants are performed in diabetic patients who have previously received kidney transplants and already require immunosuppression. For nonuremic patients, pancreas transplants are performed only if it is judged that their complications of diabetes exceed, or predictably will exceed, the potential side effects of chronic immunosuppression.