Vascularized whole pancreas transplantation is currently the only therapeutic approach consistently able to restore euglycemia in patients with type 1 diabetes. More than two-thirds of all pancreas transplants are performed simultaneously with the kidney (SPK: simultaneous pancreas kidney) in patients with end-stage diabetic nephropathy. The results of SPK transplantation are excellent with rates of insulin-independence >80% at 1 year and >70% at 5 years. Venous thrombosis is the major cause of early pancreatic graft loss. Successful SPK transplantation significantly prolongs patient and kidney graft survival. Additionally, there is growing evidence that successful SPK transplantation can stabilize or even reverse some of the chronic secondary complications of diabetes.
Pancreas-after-kidney (PAK) transplantation is an interesting option for candidates for SPK transplantation who have a living kidney donor. Pancreas transplantation alone (PTA) is increasingly performed and is offered to type 1 diabetic patients with glycemic lability (hypoglycaemia unawareness). PAK and PTA together comprise <30% of all pancreas transplants, and their success rate is improving, but slightly lower than for SPK, probably because rejection is more difficult to diagnose.
Current research efforts in the field are mainly focusing on the following issues:
1. Defining strategies to reduce the ischemia-reperfusion injury thought to be responsible for the majority of early technical pancreatic graft losses.
2. Expanding the pancreas donor pool, notably through the use of living donors.
3. Exploring the potential of early PTA in preventing the development of end-stage nephropathy.
4. Identifying subsets of patients with type 2 diabetes eligible for pancreas transplantation with similar chances of success.
5. Exploring the role of minimally invasive surgery and surgical new technologies in pancreas procurement and transplantation.
30 Apr - 04 May 2011
European Society of Endocrinology