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Pancreas Transplantation

             Pancreas transplantation evolves as a strategy in management of diabetes mellitus. The first pancreas transplantation was performed in 1966 by the team of Dr. Kelly, only three years after the first kidney transplantation. The first pancreas-kidney transplant was reported in 1967. In 1979, the first's living-related partial pancreas transplantation was done (Larsen, 2004). .
             The endocrinologist remains involved in the care of the pancreas transplant recipients even when glucose is normal, because of the numerous of issues encountered post transplantation. A multidisciplinary team is needed to maximize long-term quality, as well as quality of life for pancreas transplant recipients. .
             The primary indication for pancreas transplantation is to provide a vital source of insulin for patients with severe insulin depended diabetes mellitus. Many of this patients have diabetic nephropathy and the pancreas transplantation is commonly (90 % of all patients) combined with simultaneous renal transplant. Ideal candidate is patient with type I diabetes, younger then 45 years of age and with end stage renal disease, and have no or little atherosclerotic disease. Most transplants are whole organs transplants harvested from cadavers, and the same applies for renal transplants too. Live donor grafts are always segmental, they have smaller mass or beta cells, and have higher risk of thrombosis. .
             The total number of pancreas transplants reported to United Network of Organ Sharing (UNOS) and the International Pancreas Transplants Registry (IPTR) is 18.843,00 from December 1966 to October 2002, with most performed in the United States 13.951,00 (Larsen, 2004). .
             Diabetes as etiology of end stage renal disease (ESRD) has doubled over the last decade, and because of this, patients are eligible for pancreas-kidney transplant simultaneously. This simultaneous transplantation noticeably improves patient's survival rate in diabetic ESRD, compared with dialysis, especially if performed early.

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