[Pancreas transplantation: who and when?].
Hyperglycemia is an important factor in the development and progression of the complications of diabetes. Pancreas transplantation is currently the only method able to achieve sustained normoglycemia in type I diabetes. By now, this procedure has become an accepted treatment option combined with kidney transplantation for selected patients with end-stage diabetic nephropathy. The definite benefits of pancreas transplantation comprise relieve from insulin administration, superb glycemic control, improved quality of life and long-term survival of patient with severe autonomic neuropathy. Presumed benefits represent stabilization or slowing of progression of microvascular complications. Definite disadvantages are the risk of the surgical procedure, graft rejection and the necessity of permanent immunosuppression. Isolated pancreas transplantation in nonuremic type-1 diabetic patients is still controversial. Diabetic complications of the potential recipient have to be potentially correctable by the transplantation and their significance must exceed all risks of the operation and life-long immunosuppression. Currently, approx. 25 combined transplants are performed per year in IKEM with the results comparable to those reported by the International Pancreas Transplant Registry. Seven nonuremic type-1 diabetic recipients of 8 operated in IKEM by June 2000 have been insulin-independent for 1-33 months. The main indication for isolated pancreas transplantation is brittle diabetes with hypoglycemia unawareness syndrome and labile diabetes with severe autonomic neuropathy and rapid progression of microangiopathy despite appropriate intensified insulin therapy.
Saudek
F
F
Klinika diabetologie Centra diabetologie Institutu klinické a experimentální medicíny, Praha.
Boucek
P
P
Adamec
M
M
D001786:Blood Glucose / Q000032:analysis; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000601:surgery; D006801:Humans; D016030:Kidney Transplantation; D016035:Pancreas Transplantation / Q000009:adverse effects; D018579:Patient Selection; D012307:Risk Factors
D001786:Blood Glucose