Progress in segmental pancreatic transplantation

Abstract

Twenty‐nine patients with type I diabetes mellitus and end‐stage diabetic nephropathy were subjected to combined renal and pancreatic transplantation. The 2‐year actuarial patient survival rate was 87% and the renal graft survival rate was 78% for the whole series. The 1‐year and 2‐year actuarial pancreatic graft survival rates were 54% and 40%, respectively. A substantial improvement in the pancreatic graft survival has occurred with time. Thus, in the first part of the series (1981–1983, n = 13), the 1‐year pancreatic graft survival was 31%, whereas in the second part of the series (1984–1985, n = 16), the figure was 75%. The improvement in results was probably due to a reduction in the cold ischemia time and the adoption of an aggressive anticoagulant treatment; using these measures the incidences of pancreatitis and graft thrombosis were much reduced. In all patients with functioning pancreatic grafts, insulin therapy was discontinued and an essentially normal glucose homeostasis was achieved. Among the patients whose pancreatic transplant has survived for a longer period, no further deterioration in retinopathy or neuropathy was found. Furthermore, biopsies from the simultaneously transplanted kidneys in 2 patients 3 years after transplantation have failed to show any increase in the thickness of the glomerular basement membrane indicative of a recurrence of diabetic nephropathy.