title: Surgical treatment of diabetes mellitus with pancreas transplantation.
abstract: OBJECTIVE
  The authors compared results and morbidity in insulin-dependent diabetes mellitus (IDDM) patients undergoing preemptive pancreas transplantation (PTx) either before dialysis or before the need for a kidney transplant with IDDM patients undergoing conventional combined pancreas-kidney transplantation (PKT) after the initiation of dialysis therapy.
  
  
  BACKGROUND
  Combined PKT has become accepted generally as the best treatment option in carefully selected IDDM patients who either are dependent on dialysis or for whom dialysis is imminent. With improving results, the timing of PKT relative to the degree of nephropathy is evolving. However, it is not well established that the advantages of preemptive PTx can be achieved without incurring a detrimental effect on graft function or survival.
  
  
  METHODS
  Over a 4-year study period, data on the following 3 recipient groups were collected prospectively and analyzed retrospectively: 1) 38 IDDM patients undergoing combined PKT while on dialysis (PKT:D); 2) 44 IDDM patients undergoing preemptive PKT before dialysis (PKT:ND); and 3) 20 IDDM patients undergoing solitary PTx. All patients underwent whole organ PTx with bladder drainage and were treated with quadruple immunosuppression.
  
  
  RESULTS
  Actuarial 1-year patient survival is 100%, 98%, and 93%, respectively. One-year actuarial PTx survival (insulin-independence) is 92%, 95%, and 78%, respectively. The incidence of rejection, infection, operative complications, readmissions, and total hospital days was similar in the three groups. Long-term renal and pancreas allograft function and quality of life were similarly comparable. Rehabilitation potential favored the solitary PTx and PKT:ND groups.
  
  
  CONCLUSIONS
  Preemptive PKT or solitary PTx performed earlier in the course of diabetes is associated with good results, facilitated rehabilitation, and may prevent further diabetic complications.
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha.
authors.forename: R J
authors.initials: RJ
authors.lastname: Stratta
authors.forename: R J
authors.initials: RJ
authors.lastname: Taylor
authors.forename: J S
authors.initials: JS
authors.lastname: Bynon
authors.forename: J A
authors.initials: JA
authors.lastname: Lowell
authors.forename: R
authors.initials: R
authors.lastname: Sindhi
authors.forename: T O
authors.initials: TO
authors.lastname: Wahl
authors.forename: T F
authors.initials: TF
authors.lastname: Knight
authors.forename: L G
authors.initials: LG
authors.lastname: Weide
authors.forename: W C
authors.initials: WC
authors.lastname: Duckworth
mesh_terms: D000206:Actuarial Analysis; D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D011446:Prospective Studies; D012189:Retrospective Studies