Pancreas Transplant at Taipei Veterans General Hospital

Abstract

Background: Insulin-dependent diabetes mellitus (IDDM) or Type 1 diabetes eventually leads to nephropathy, neuropathy, retinopathy and angiopathy after 10 - 30 years. Currently, pancreas transplant is the treatment of choice in tight control of blood sugar for IDDM patients, and further to stabilize, prevent or even to reverse the diabetic complications. According to the International Pancreas Transplant Registry (IPTR) and United Network for Organ Sharing (UNOS), over 25,000 cases of pancreas transplant have been performed worldwide, with an increase of more than 1,600 - 1,800 cases per year, mainly in the USA. The 1-year pancreas graft survival rate is 86.0% and 5-year is 69.8%, very close to those of kidney transplant. Among the whole pancreas transplants, 80% are simultaneous pancreas-kidney transplant (SPK), 15% pancreas after kidney transplant (PAK), and 5% pancreas transplant alone (PTA). Materials: From 2003 to 2011, there were 73 pancreas transplants performed for 69 patients at Taipei Veterans General Hospital, with 27 SPK, 7 PAK, 35 PTA and 4 PBK. Results: The blood sugar usually returned to normal level within 5 hours (median) after revascularization of the pancreas grafts. The fasting blood sugar maintained within normal range thereafter throughout the whole clinical course in most cases. The technical success rate was 95.5%. There were 8 graft loss, due to acute rejection in 1, chronic rejection in 2, technique failure in 3 and 2 died with functioning graft, and 4 of them received another successful re-transplant. All SPK patients are free from dialysis, but 1 primary nonfunction of kidney graft. Post-transplant infection disease included 5 CMV gastroenterocolitis, 1 CMV pneumonia, 4 UTI (urinary Tract Infection), 2 BK virus infection,3 herpes zoster infection, 1 pseudomembraneous colitis, 2 varicella zoster infection, 1 skin infection with MRSA and cryptococcus, 2 bacteria pneumonia, 1 sepsis. Conclusion: Pancreas transplant provided an ideal insulin-free solution for DM, especially IDDM. Pancreas transplant could be performed with similar successful rate of kidney transplant if they were done simultaneously.