Pancreas transplantation: experience at University of Texas, Houston.
BACKGROUND
Diabetes mellitus is a spectrum of diseases characterized by the absence of glycemic control and the development of secondary complications. Type 1 diabetes (insulin-dependent) accounts for a minority of cases, but it usually presents in younger age groups. This disease significantly affects quality of life.


METHODS
We retrospectively reviewed the cases of pancreas transplantation performed at University of Texas, Houston, from February 2008 to August 2009. All patients received immunosuppression induction with thymoglobulin (1.5 mg/kg). We used 3 drugs for maintenance: tacrolimus, mycophenolic acid, and prednisone. All patients received cytomegalovirus prophylaxis.


RESULTS
We transplanted 54 organs in 29 patients with type 1 diabetes mellitus. The mean patient age was 42 years. Patients had diabetes mellitus type 1 for an average of 28.82 years and were on dialysis for an average of 2 years. Nineteen patients were male (65%). Complications ensued in 68% of cases (20 patients), 9 of which required surgical exploration (31%). We lost 3 pancreatic allografts.


CONCLUSIONS
Pancreas transplant recipients constitute a unique population with a high risk of complications in the acute setting. During the first 3 months after simultaneous pancreas-kidney transplantation the relative mortality risk is increased but after a year it has clear advantage over diabetic patients on dialysis waiting for a transplant. To date, 26 patients have functional pancreatic allografts and 29 are dialysis-free. Pancreas transplantation is a challenging procedure. Surgeons must be prepared to aggressively manage the possible complications.
Cicero
A
A
University of Texas, Houston, Houston, Texas, USA. Alejandra.Cicero@uth.tmc.edu
Lappin
J A
JA
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000961:Antilymphocyte Serum; D000998:Antiviral Agents / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000517:prevention & control; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000601:surgery; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000627:therapeutic use*; D016035:Pancreas Transplantation / Q000276:immunology / Q000706:statistics & numerical data*; D011241:Prednisone / Q000627:therapeutic use; D012189:Retrospective Studies; D016559:Tacrolimus / Q000627:therapeutic use*; D013781:Texas
D000911:Antibodies, Monoclonal; D000961:Antilymphocyte Serum; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; C512542:thymoglobulin; D009173:Mycophenolic Acid; D011241:Prednisone; D016559:Tacrolimus