[Frontiers in Bioscience 2, e34-40, August 1, 1997]|
PANCREAS TRANSPLANTATION: INDICATIONS, CLINICAL MANAGEMENT, AND OUTCOMES
John P. Leone, MD, PhD1, Abhinav Humar1 , Rainer W. G. Gruessner, MD, PhD2, and David E.R. Sutherland, MD3
1Transplant Fellow, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, 2Professor & Chief, Section of Pancreatic Transplantation, Department of Surgery University of Minnesota, Minneapolis, Minnesota, 3Professor & Chief, Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
Received 6/15/97; Accepted 6/23/97; On-line 7/25/97
Until the late 1960's, various methods of exogenous insulin therapy were the sole means of treating Type 1 (insulin-dependent) diabetes mellitus. However, during the past three decades, many advances have been made in the surgical approach to the treatment of this disease entity. The first pancreas transplant was performed by Kelly and Lillihei in 1966 and during the ensuing 7 years, 14 additional transplants were performed by this team (1). While the initial results were quite dismal, the efforts of these surgeons demonstrated that successful pancreas transplantation could achieve insulin-independence and that long-term function (up to 1 year) was possible. Since then, new immunosuppressive agents and advances in surgical technique have improved outcomes. By 1996, a total of over 8,800 pancreas transplants have been performed world-wide with insulin independence rates at 1 year surpassing 80% in some recipient categories (2,3). The following review discusses the evolution of pancreas transplantation and demonstrates how improved surgical technique combined with the development of newer immunosuppressive agents have contributed to the efficacy of this procedure as a cure for Type 1 diabetes.