Pancreatico-duodenal allotransplantation: experimental and clinical experience

Abstract

A procedure has been developed in the laboratory for pancreatico-duodenal allotransplantation in the pancreatectomized dog. Dogs with such grafts have survived for many months when treated with azathioprine and prednisone to prevent rejection. Contrary to usual beliefs, the pancreas is not particularly sensitive to total ischemia since it has been possible to preserve a pancreatico-duodenal allograftin vitro with only hypothermia and hyperbaria up to 24 hours. Such preserved pancreatico-duodenal grafts have then been allotransplanted into pancreatectomized dogs with survival of the dogs for long periods. We have now done pancreatico-duodenal allotransplantation in ten patients with juvenile onset diabetes mellitus and renal failure. Nine of these patients have received a renal allograft taken from the same cadaver simultaneously. In all but one of these patients the pancreas has functioned immediately. This exception was in a patient who received a pancreatico-duodenal allograft taken from a cadaver which had suffered irreversible ischemia. While only two patients are currently living, the longest eleven months, in no case we have seen evidence of pancreatic rejection. In seven of the eight deaths problems concerned with the cadaver renal allograft were at fault and in only one patient was the pancreatico-duodenal allograft the cause of death. This patient died seven months after pancreatico-duodenal allografting from an acute perforation of the duodenal graft. It is clear from these studies that the pancreas is far less antigenic than the kidney and possibly of other organs as well. Pancreatico-duodenal allotransplantation alone is now planned for juvenile onset diabetics who have significant but not terminal renal nephropathy. If the characteristic vascular disease of diabetes mellitus can be altered by a pancreatic allograft, then this will become one of the most commonly performed transplant procedures.