[Pancreas transplantation: a survey on indications, surgical techniques, immunosuppression, complications and outcome]

Abstract

Since its introduction in 1966, pancreas transplantation has undergone considerable progress. Refinements in surgical technique, better organ preservation solutions, and more potent immunosuppressive therapies have improved patient and graft-survival rates dramatically. Survival rates for patient and pancreas at 1 year approach 95 and 83 %, resp., for simultaneous pancreas and kidney transplantation, and 97 and 78 %, resp., for pancreas alone. US pancreas graft and patient survival rates do not significantly differ from the results of the European centers. However, there is still a hesitant acceptance of combined pancreas-kidney transplantation in Germany. Combined pancreas-kidney transplantation is nowadays the treatment of choice in carefully selected patients with type 1 insulin-dependent diabetes mellitus and end-stage renal failure. Many US centers even advocate combined transplantation in diabetic patients at a pre-uremic stage. Pancreas transplantation significantly improves quality of life and provides excellent long-term glycemic control which halts or even ameliorates secondary diabetic complications such as microangiopathy and neuropathy. In addition, there is increasing evidence that successful pancreas transplantation significantly prolongs patient survival mainly by a reduction of cardiovascular-related mortality. Current 10-year patient survival rate after SPK exceeds 70 %. For diabetics with end-stage renal disease there is no alternative treatment available with comparable live expectancy. However, morbidity and mortality after SPK is still higher than for kidney transplantation alone in the first year. Outcome of isolated pancreas transplantation is also improving but this technique is still restricted to non-uremic patients with severe diabetic complications or with brittle diabetes and severe impairment of quality of life.