Pancreas Transplantation

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.