Survival After Pancreas Transplantation in Patients With Diabetes and Preserved Kidney Function

Abstract

ANCREATIC TRANSPLANTATION IS a therapeutic option for patients with complicated diabetes mellitus. The American Diabetes Association supports the procedure for patients with diabetes who have had, or need, a kidney transplant. In the absence of kidney failure, pancreas transplantation may be considered for patients with diabetes and severe and frequent metabolic instability (ie, hypoglycemia, ketoacidosis). 1 Despite current controversy, and while the annual number of simultaneous pancreas-kidney transplants remained stable from 1995 to 2002, over that same interval the annual number of solitary pancreas transplants (ie, pancreas transplant alone or pancreas-after-kidney transplant) increased 5-fold (United Network for Organ Sharing/Organ Procurement and Transplantation Network [UNOS/OPTN] data as of May 2, 2003).Specific US transplant numbers document this trend: 910 simultaneous pancreas-kidney transplants were performed in 1995 and 902 were performed in 2002 . In contrast, in 1995

Glycemic Control in Simultaneous Islet-Kidney Versus Pancreas-Kidney Transplantation in Type 1 Diabetes: A Prospective 13-Year Follow-up

“…Both transplantation options can be conducted alone or in combination with a kidney. Whereas simultaneous pancreaskidney (SPK) transplantation is an intervention with proven benefits in terms of survival (4), conflicting results in pancreas transplantation alone have been published (5,6).…”

Avoiding Toxicity: Insulin Placement in the Portal Vein

“…Additionally, pancreas transplantation particularly with its need for immunosuppression has not always increased survival in transplant recipients [18]. However, a number of clues suggest that insulin placed in the portal venous system is less-causative of hypoglycemia [11,12,15,19], may lead to less local vessel stenosis in the infused location and better vessel neointimal growth after injury [20], and may avoid peripheral hyperinsulinemia.…”

The AJT Report

“…3 One conclusion was that a the survival of waiting-list patients receiving conventional therapy. Although authors of a rebuttal letter that also appeared in the journal stated that they arrived at a different conclusion based on the same data, the letter received little publicity.…”