PANCREAS AND KIDNEY-PANCREAS TRANSPLANTATION
Pancreas transplantation provides a primary cure for DM by providing
nearly physiologic insulin replacement. Nephropathy develops in about 50% to 60%
of insulin-dependent diabetic patients, so it is common to also transplant a kidney
at the time of pancreas transplantation. The appearance of new immunosuppressants
such as tacrolimus and mycophenolate mofetil has dramatically increased pancreas
graft survival.[147]
The best results in terms
of graft survival are obtained with simultaneous pancreas-kidney transplantation
(SPK), but good results are also achieved with a pancreas transplant alone (PTA)
or a pancreas transplant after successful kidney
transplantation (PAK). Diabetic patients who undergo SPK have greater long-term
survival than do diabetics who receive a cadaver kidney alone.[148]
In 2002, 550 pancreas transplants and 905 SPKs were performed
in the United States. More than 16,000 pancreas transplants have been performed
worldwide according to the International Pancreas Transplant Registry. The 3-year
graft survival rate ranges from 60% to 80%. Almost 4000 patients are on wait lists
for either PTA or SPK, with the average waiting time currently being 1 to 2 years.
Organ Matching and Allocation
Solid organ pancreas transplantation is indicated for the treatment
and cure of both type 1 and select patients with type 2 DM (less than 5%). Pancreas
transplantation can also be considered in patients with DM secondary to chronic pancreatitis
or CF. Pancreas transplantation may also be performed in conjunction with total
pancreatectomy for nonmetastatic pancreatic cancer.
The initial testing determines the major blood group (ABO) compatibility
and HLA profile of the recipient. These data are used for the initial matching of
donor to recipient. A final check is made at crossmatch when recipient blood is
mixed with donor blood cells to determine whether the recipient has preformed reactive
antibodies against donor antigens.
