Preface to topic “Living donor pancreas transplantation”

Abstract

Pancreas transplantation is an established treatment for type 1 diabetic patients. The outcome of pancreas transplantation has rapidly improved in association with improvements in the surgical procedure and a newly developed immunosuppressive regimen. The pancreas was the first extra-renal organ to be transplanted successfully from living donors, at the University of Minnesota in 1979 [1]. A simultaneous pancreas and kidney transplantation from a living donor was first successfully performed for a diabetic patient with end-stage renal disease at the same institution in 1994 [2]. In Japan, only seventy-four pancreas transplantations from deceased donors have been performed since the first pancreas transplantation was performed by Fukao et al. in 1984 [3]. Unfortunately, twenty-three diabetic patients on the waiting list to undergo pancreas transplantation in the Japan Organ Transplant Network died during the 10-year period from 1999 to 2008 [4]. Based on a severe shortage of deceased donors in this country and the poor prognosis of diabetic patients, especially those with end-stage renal disease, the first simultaneous pancreas and kidney transplant from a living related donor was successfully introduced in Japan by Kenmochi et al., on 7 January 2004 [5]. Seventeen living donor pancreas transplants have since been performed in this country, with an excellent outcome (unpublished data). The concept of living donor organ transplantation presents ethical, legal, medical, social, and psychological challenges. In addition, the most important issue in living donor pancreas transplantation must be to protect the donor against the development of diabetes by ensuring the preservation of the donor’s endocrine function after the distal pancreatectomy. The donors of pancreas transplants may develop insufficient glucose tolerance after surgery because the pancreas lacks the ability to regenerate. This problem remains unsolved. This topic was selected to clarify the current status of living donor pancreas transplantation both worldwide and in Japan. All three authors are clinical doctors actively at work in the field of living donor pancreas transplantation. I hope this topic may provide some helpful information for the treatment of severe diabetic patients.