Fetal pancreatic transplantation

Abstract

S ince the first pancreas transplantation was performed in 1966 it has been repeatedly demonstrated that by transplanting most or all of the pancreas as a vascularized organ to patients with insulin-dependent diabetes mellitus (IDD~l), norrnoglycemia is achieved without the need for insulin injections. The procedure has become more frequent in recent years and success rates have been markedly improved," However, there arc three major problems that remain: (1) results with a pancreas transplantation that has not been combined with previous or simultaneous kidney transplantation have, in most studies, been discouraging and therefore the treatment can not be offered until late complications (ie, renal failure) have already occurred; (2) it is difficult to foresee that recipients ofvascularized organ grafts will not have to commit to a life-long regimen of immunosupprcssives; (3) because the primary objective of transplanting endocrine pancreatic tissue is to achieve insulin independency sufficiently carl}' in the course of the disease for prevention oflate complications, most patients with IDD~1should be candidates for this kind of therapy and, taking this into account, there \\;11 be a considerable donor organ shortage. It should also be kept in mind that, because the whole-organ procedure per se is not lifesaving, it has become a much debated procedure and is questioned by many diabctologists.' Concurrent with the development of the wholeorgan transplantation technique as an alternative approach, islet cell transplantation has been pursued. The idea of replacing only the desired endo-