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CLINICAL REVIEW 25 Current Status of Pancreas Transplantation

Department of Surgery, University of Minnesota Hospital Minneapolis, Minnesota 55455

Address requests for reprints to: David E. R. Sutherland, M.D., Ph.D., Department of Surgery, University of Minnesota Hospital, Minneapolis, Minnesota 55455.

PANCREAS transplantation is the only treatment of Type I diabetes that establishes an insulin-independent euglycemic state (1, 2). Glycosylated hemoglobin levels are normalized for as long as the graft functions (3). The penalty for achieving such a state is the need for immunosuppression. In contrast to heart and liver grafts, pancreas transplantation is not a life-saving procedure. Thus, for nonuremic patients with or without early nephropathy, pancreas transplants have been performed only when the problems of diabetes were perceived to be more serious than the potential side-effects of antirejection drugs (4). However, for uremic diabetic patients who are already best treated by a kidney transplant, the addition of a pancreas has become routine (5, 6), since such patients are already obligated to immunosuppression (currently a combination of cyclosporine, azathioprine, and corticosteroids for maintenance, with antilymphocyte agents used for induction therapy or treatment of rejection episodes).

Effect on secondary complications of diabetes

In nonuremic patients, a successful

Received January 25, 1991.