Perspectives in the clinical application of pancreatic transplantation in the diabetic
The original publication is available at http://www.samj.org.za
Until June 1983 a total of 280 human pancreatic transplantations had been performed world-wide. Until July 1983, 57 were functioning (22%), 11% for more than 12 months. During the past 5 years a steady increase in the number of segmental transplants has been observed. In most cases simultaneous transplantation of pancreas and kidney was performed (144 cases), in 65 cases the pancreas was transplanted metachronously after kidney grafting, and in 64 cases pancreatic transplantation was performed alone. Currently, segmental or whole pancreatic transplantation is the favoured procedure. Islet transplantation has been disappointing because of the difficulty in procuring sufficient numbers of islets from an adult pancreas followed by immunological destruction of the transplanted islets. Most pancreas grafts have been procured from cadavers, but the favoured segmental technique allows living related donors to be used. After rejection the graft does not always have to be removed and exogenous insulin administration may be resumed, either permanently or until re-transplantation can be accomplished. Life-long immunosuppression is needed after transplantation and currently pancreatic allograft survival rates for cyclosporin (CSA) and azathioprine-treated patients have been similar. The longest survival of a living diabetic recipient with a functioning pancreas is 5 1/2 years. Some authors have recently claimed improvement and stabilization of impaired nerve conduction and diabetic retinopathy after pancreatic transplantation.
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