Over 500 solitary pancreas transplants in nonuremic patients with brittle diabetes mellitus.

Abstract:

BACKGROUND:A pancreas transplant alone (PTA) in a nonuremic patient with brittle diabetes mellitus remains a rare procedure because the tradeoff for insulin independence is lifelong immunosuppression. METHODS:Herein we report our results at the University of Minnesota of 513 PTAs from December 17, 1966, through December 31, 2006. Of these recipients, 87% had previously experienced hypoglycemic unawareness and 23% experienced coma and/or seizures. These transplants spanned four immunosuppressive eras: pre-cyclosporine A (pre-CsA) era (16%), CsA era (23%), tacrolimus (TAC) era (47%), and calcineurin-inhibitor (CNI)-free era (14%). RESULTS:The overall patient survival rate at 1 year posttransplant was about 95%; at 5 years, it was 90%. The pancreas graft survival rate at 1 year increased significantly from the pre-CsA era (31%) to the TAC era (75%), thanks to a significant decline in immunologic and technical failures. The CNI-free protocol, because of its high infection and hematologic infection rate, did not further improve outcome. Risk factors for subsequent kidney failure (13% at 5 years posttransplant) were serum creatinine levels>1.5 mg/dl at the time of the pancreas transplant and recipient age<30 years. CONCLUSIONS:A technically successful PTA is currently the only treatment option that allows nonuremic patients with brittle diabetes to become insulin-independent in the long term.

journal_name

Transplantation

journal_title

Transplantation

authors

Gruessner RW,Sutherland DE,Kandaswamy R,Gruessner AC

doi

10.1097/01.tp.0000296820.46978.3f

subject

Has Abstract

pub_date

2008-01-15 00:00:00

pages

42-7

issue

1

eissn

0041-1337

issn

1534-6080

pii

00007890-200801150-00008

journal_volume

85

pub_type

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