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

Transplantation. 2008 Jan 15;85(1):42-7. doi: 10.1097/01.tp.0000296820.46978.3f.

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.

MeSH terms

  • Adolescent
  • Adult
  • Cyclosporine / therapeutic use
  • Diabetes Mellitus, Type 1 / surgery*
  • Female
  • Graft Survival / immunology
  • Humans
  • Immunosuppression*
  • Immunosuppressive Agents / therapeutic use
  • Kidney Transplantation
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pancreas Transplantation / immunology*
  • Pancreas Transplantation / methods
  • Pancreas Transplantation / statistics & numerical data*
  • Renal Dialysis
  • Retrospective Studies
  • Risk Factors
  • Survival Rate
  • Tacrolimus / therapeutic use
  • Treatment Outcome

Substances

  • Immunosuppressive Agents
  • Cyclosporine
  • Tacrolimus