Pancreas transplantation: The Minnesota experience

Abstract

Between July 1978 and April 1987, a total of 182 pancreas transplants were performed at the University of Minnesota. For the first 100 cases (through October 1984), a variety of surgical techniques and immunosuppressive regimens were used, and 1 year patient and graft functional (insulin-independent) survival rates were 88% and 27%, respectively. From November 1984 to April 1987, a triple therapeutic drug regimen of cyclosporine, azathioprine, and prednisone was used for maintenance immunosuppression, and bladder drainage (BD) (n=39; 38 cadaver (CAD) and 1 related (REL) donor graffs) and enteric drainage (ED) (n=40;21 CAD and 19 REL donor grafts) techniques were compared in 59 nonuremic, nonkidney (NUNK) transplant reciplents, 21 recipients of previous kidney (PK) transplants and 8 uremic recipients of simultaneous pancreas and kidney (SPK) transplants. The survival rates were higher in recipients of BD CAD and ED REL than of ED CAD gratts (58% and 59% versus 29% at one year for all, and 84%, 84% and 40% for technically successful cases), but patient survival rates were similar (90%, 93% and 90% at one year). BD allows for early diagnosis of rejection based on urine amylase monitoring, and REL grafts are less prone to incite rejection; thus, we are currently performing only BD for grafts from CAD donors, while both techniques are used for REL donor grafts. Functional survival rates since November 1984 in the three categories of recipients of pancreas grafts transplanted by currently applied techniques were higher in NUNK and SPK than in the PK category (63% and 75% vs. 46% at 1 year), primarily because of a higher technical fallure rate in the latter category (the corresponding figures for technically successful transplants at 1 year were 81%, 100%, and 89%). Serial kidney biopsies have shown reduction of glomerular mesangial volume in recipients of functioning grafts, but this favorable finding is offset by the occurrence of lesions of cyclosporine nephrotoxicity. Retinopathy progressed during the first year in 44% of patients with functioning grafts, but neuropathy improved with significant increases in motor nerve conduction velocities. Pancreas transplants are currently being performed in patients whose complications of diabetes are thought to be more serious than the side effects of immunosuppression. Logn-term observations and comparison with a control group will be necessary to document the validity of this approach to other than kidney transplant recipients, because preliminary observations show mixed results in regard to the evolution of pathology in the various organ systems at risk for serious complications of either diabetes or immunosuppression.