An experience of pancreas and islet transplantation in patients with end stage renal failure due to diabetes type I.
OBJECTIVE
The aim of this article is to describe the current decision-making in an institution with availability of a programme for simultaneous pancreas-kidney transplantation and a programme for islets after kidney transplantation. This rather subjective review is supported by a background of a description of the institutional experience of these two methods. A further aim is to give the reader the message that this not a static problem but rather an evolutional/developmental process.


RESULTS
The article is based on objective numbers and encounters and mixed with personal comments. The most important observation in whole-organ pancreas transplantation is that it works very well for selected patients. The key reflection on patients undergoing islets transplantation is that the one of the things that we have not measured in objective terms is quality of life parameters. In our centre, we regret this, as we think that best subjective achievement for the patients is just that, a better quality of life.


CONCLUSIONS
Both procedures have their advantages and drawbacks. At the moment, they do not substantially compete for organs of deceased donors. Successful islet transplantation has a much shorter history, which may allow for future developments at a more rapid scale than whole pancreas in the near future. At the moment, I consider the two procedures as supplementary rather than competitive in the treatment of diabetes type I with a need for treatment of end-stage renal failure.
Tufveson
Gunnar
G
Department of Transplantation, Uppsala University Hospital, Uppsala, Sweden. gunnar.tufveson@akademiska.se