With respect to pancreas transplants, the ICSI Technology Assessment Committee finds the following:
Nearly all uremic diabetics are candidates for a kidney transplant and most should also receive a pancreas either simultaneously (SPK) or sequentially (PAK). For those who have a living donor for a kidney, PAK is preferable to waiting years for a cadaver SPK. Experience with pancreas transplant for type 2 diabetes is more limited than for type 1 diabetes; approximately 6% of pancreas transplants are done in patients with type 2 diabetes and about 94% are done in patients with type 1 diabetes.
Long-term patient survival in SPK recipients is higher than diabetic kidney alone (KTA) recipients (Conclusion Grade II). Studies also have shown higher patient survival rates for PAK as compared to KTA. SPK rejection loss rates and risks of immunosuppression have been similar to those for KTA. One-year pancreas GSRs are about the same for PAK and SPK, but long-term pancreas GSRs are slightly higher for SPK than for PAK. The difference seems to be related to the difficulty in diagnosing rejection in an isolated pancreas graft before the situation becomes irreversible. New effective immunosuppressive drugs have reduced the number of rejection episodes in SPK and PAK, but it is still more difficult to detect rejection of the pancreas graft in PAK as compared to SPK. SPK and PAK have been shown to prevent recurrence of diabetic nephropathy in the transplanted kidney and to at least stabilize neuropathy.
PTA has been done mostly in patients with hypoglycemic unawareness or labile diabetes (including patients with frequent episodes of ketoacidosis) due to the limited treatments available for these patients. These patients have failed insulin-based management and may have incapacitating clinical or emotional problems with exogenous insulin therapy. Once a patient is insulin independent after a pancreas transplant, profound hypoglycemic events do not occur. However, any gains from insulin independence must be weighed against the side effects of immunosuppression. PTA has high patient survival rates similar to SPK and PAK and GSRs similar to PAK. PTA has shown at least a stabilization of neuropathy.
Pancreas transplants should only be done at accredited facilities by appropriately trained and experienced surgeons.