PANCREAS TRANSPLANTATION

There are approximately 118,075 patients who are on the organ transplant waiting list in the United States today. Approximately 934 individuals are waiting for a pancreas transplant and 1,710 are waiting for a combined kidney/pancreas transplant. It was in 1966 that two pioneering surgeons from the University of Minnesota, Dr. W.D. Kelly and Dr. Richard Lillehei performed the first successful pancreas transplant in a diabetic patient with renal failure.

The purpose of doing a pancreas transplant is to cure type 1 diabetes and achieve complete insulin independence. Approximately, 75 % of pancreas transplants today are performed on type 1 diabetics who also have renal failure and therefore receive a simultaneous kidney and pancreas transplant . This ensures that along with curing diabetes, renal failure is treated as well. Simultaneously transplanting both organs from the same deceased donor has been shown to work better with increased long term survival for both the kidney and the pancreas. Approximately 15 % of total pancreas transplants done today are on patients who have received a kidney transplant previously, technically known by the term pancreas after kidney transplant. The remaining 10 % of pancreas transplants are done in an isolated fashion known as pancreas transplant alone in patients with brittle type 1 diabetes who are otherwise without any kidney disease. A relatively newer option is islet transplantation, which has generally inferior long term results compared to whole organ pancreas transplantation.

There are an estimated 1,100,000 type 1 diabetics in the United States today, and 35,000 new cases are diagnosed every year. The total annual cost of diabetes exceeds $ 90 billion every year- this includes hospital and physician care, laboratory tests, pharmaceutical products, workdays lost and premature death. Presently, there is no practical insulin-delivery method coupled with an effective glucose sensory device that can replace the pancreas to achieve a constant euglycemic state. Most secondary problems of diabetes occur because of hyperglycemia such as nephropathy, sensory neuropathy, retinopathy and vascular complications and a successful pancreas transplant will work towards ameliorating these complications.

Approximately 1200 pancreas transplants are performed in the US every year. There are close to a 100 transplant centers that do this procedure but the number of transplants is limited due the donor organ shortage. The national 1 year patient, kidney and pancreas survival rates for recipients after a simultaneous pancreas and kidney transplant are 95 %, 91 % and 86 % respectively. Recipients of a pancreas after kidney transplant or pancreas transplant alone have a 1 year graft survival rate of 78-83 %.