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Types of Pancreas Transplantations .
1) Simultaneous pancreas-kidney transplant from the same donor.
2) Pancreas-after-kidney transplant, in which cadaveric or deceased donor is used for pancreas, and a living or diseased donor for the kidney.
3) Pancreas transplant alone for patient with type I diabetes, usually these are the youngest patients (only about 5% ).
4) Living donor pancreas transplant is very rare (0.5% of all the transplantations) .
5) Islet transplantation, which is still considered experimental procedure.
Islets are longer, and they are housing several different types of cells including beta cells. They are taken from the pancreas of a diseased donor, purified, processed, and transferred into another person. Once implanted, the beta cells in these islets begin to make and release insulin. Researches hope that islet transplantation will help patients with type I diabetes live without daily injection.
In patients with insulin dependent diabetes mellitus and end-stage renal disease, simultaneous transplant is successful treatment that improves quality of life and the survival rate. Typically, such patients have severe complications such as retinopathy and vascular diseases, which may be stabilized and even reversed. Simultaneous transplant has now a one-year graft survival at almost 90%, due to improved organ preservation technique, contemporary surgical techniques, and immunosuppressants. .
Surgical techniques.
Traditionally whole organ pancreatic transplantation involves arterial anastomosis of the axis/splenic artery with external iliac artery. The systemic drainage happens with anastomosis of the splenic/portal vein to the external iliac vein. The drainage of pancreatic exocrine secretions is established into the bladder through an attached segment of the duodenum. Vascular anastomosis are made end-to-side, where the donor's splenic artery and the SMA may be joined in Y graft and then anastomosed to the iliac artery.