5. Pancreas Transplantation

  1. Nizam Mamode1 and
  2. Raja Kandaswamy2
  1. Rajinder Singh1,
  2. David E. R. Sutherland2 and
  3. Raja Kandaswamy2

Published Online: 23 DEC 2012

DOI: 10.1002/9781118483664.ch5

Abdominal Organ Transplantation: State of the Art

Abdominal Organ Transplantation: State of the Art

How to Cite

Singh, R., Sutherland, D. E. R. and Kandaswamy, R. (2013) Pancreas Transplantation, in Abdominal Organ Transplantation: State of the Art (eds N. Mamode and R. Kandaswamy), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/9781118483664.ch5

Editor Information

  1. 1

    Guy's and St Thomas' Hospital, Great Ormond Street Hospital, London, UK

  2. 2

    Department of Surgery, University of Minnesota, Minneapolis, MN, USA

Author Information

  1. 1

    Guy's and St Thomas' Hospital, Great Ormond Street Hospital, London, UK

  2. 2

    Department of Surgery, University of Minnesota, Minneapolis, MN, USA

Publication History

  1. Published Online: 23 DEC 2012
  2. Published Print: 12 FEB 2013

ISBN Information

Print ISBN: 9781444334326

Online ISBN: 9781118483664

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Keywords:

  • pancreas transplantation;
  • diabetes mellitus;
  • T1DM;
  • β-cell replacement;
  • immunosuppression;
  • solid-organ transplantation;
  • renal replacement therapy

Summary

Pancreas transplantation has become a more applicable option for treating insulin-dependent diabetes mellitus over the last 3 decades. Type-1 diabetes mellitus has two treatments: (a)exogenous insulin administration or (b)β-cell replacement by pancreas or islet transplantation. The former is burdensome to the patient and gives imperfect glycemic control, predisposing to secondary complications of the eyes, nerves, kidneys, and other systems. The latter, when successful, establishes a constant euglycemic state but requires major surgery—at least for the pancreas transplant—and immunosuppression to prevent rejection, predisposing to complications as well, often compounded by those that are preexisting from diabetes.

Because of the established lack of sustained success with islet transplantation, solid-organ pancreas transplantation remains the gold standard for β-cell replacement. With refinement in surgical techniques, the availability of better immunosuppression, and lessons learned from previous experience, the results of pancreas transplantation have improved significantly. This improvement has brought a paradigm shift in the current approach towards a patient with diabetes mellitus, in that the main aspects considered are the overall surgical/anesthetic candidacy and the benefit in trading off the need for insulin administration to that of immunosuppression.