Pancreas transplantation

Pancreas transplantation is now the standard of care for selected patients with diabetes and end-stage renal failure, with clear benefits in duration and quality of life. The indication for transplantation in patients with other severe diabetic complications are less clearly defined and the benefits less certain. The criteria for donor selection are more rigorous than for kidney and liver transplantation; selection of suitable organs and surgical retrieval technique are critical to success as the transplanted pancreas is vulnerable to preservation injury and post-transplant pancreatitis. Modern immunosuppressive strategies have reduced rejection rates and lowered the need for steroids; this has enabled surgical developments, particularly the enteric drainage of exocrine secretions, which have further reduced postoperative complications. As well as data relating to greater life expectancy, there is increasing evidence of stabilisation or long-term improvement in retinal, cardiovascular and neurological complications of diabetes. In patients with normal renal function, pancreatic islet transplantation may provide similar benefits without the morbidity of whole organ transplantation; this may be offered to patients suffering from life-threatening episodes of hypoglycaemic unawareness.