OverviewDue to advances in immunosuppression and surgical technique, whole organ pancreas transplantation has become a viable treatment for select patients with insulin dependent diabetes mellitus (IDDM). The renal/pancreas transplant operation is performed as a combined operation for select patients with Type I , or Insulin Dependent, Diabetes.
Candidacy and Evaluation
Potential candidates for pancreas transplantation include those individuals who have end-stage renal disease (ESRD) due to IDDM and would otherwise be candidates for renal transplantation alone. The primary benefit in these patients is correction of their abnormal glucose metabolism, allowing withdrawal from insulin therapy, as well as liberalization of diet. In addition, there may be some benefit in preventing the progression of diabetic microangiopathy, particularly diabetic retinopathy.
Patients who are considered candidates for pancreas transplantation undergo the same evaluation process as do renal transplant candidates. Because the incidence of cardiac disease is high in long-standing diabetics, all patients undergo cardiac evaluation. Contraindications to the procedure include severe coronary artery disease, obesity, and severe peripheral vascular disease.
Perio-operative Care and Follow-Up
In general, the hospital stay for combined renal/pancreas recipients is somewhat longer than that for kidney transplants, and patients will remain in the hospital for 2-3 weeks. Patients who recover rapidly will be discharged to the UAB Townhouse for a total stay at the Medical Center of 4-5 weeks.
The followup of pancreas recipients is essentially the same as that for renal transplant recipients, however several additional parameters are monitored. These include fasting blood sugar, glycolylated hoemglobin levels, and urinary and serum amylase levels. Because these patients in general have the drainage of their pancreatic exocrine secretion into the bladder, it is possible to monitor amylase output in the urine as a reflection of overall function of a pancreas graft. Monitoring for graft rejection is similar to that for renal transplant patients, since it is rare for the pancreas to reject without concomitant renal rejection in a combined renal/pancreas recipient. Their follow-up schedule is also similar to that for renal transplant recipients.
Following successful pancreas transplantation, patients expect to be insulin free with normal glycosylated hemoglobin levels and normal glucose tolerance tests
Results
Approximately 85-90% of combined renal/pancreas transplant function for one year. Because this is a highly selective group of patients, the anticipated number of combined kidney/pancreas transplant procedures will be limited.
Pancreas After Kidney Transplantation
Pancreas after kidney transplantation (PAK) is intended for patients with Type I Diabetes who have already undergone successful renal transplantation. Criteria for acceptance are the same for simultaneous kidney/pancreas transplantation along with acceptable renal function.
Islet Cell Transplantation
The Islet Cell Program has yet to start. Projected enrollment should begin some time near the end of 2001. Candidates will include individuals with brittle Type I Diabetes with hypoglycemic unawareness and who are otherwise without significant diabetic sequelae. Since the procedure is still experimental, additional requirements will be discussed at the time of evaluation and listing. Referrals should be submitted to the UAB Renal Transplant Patient Care Office.