Pancreata from pediatric donors restore insulin independence in adult insulin-dependent diabetes mellitus recipients.
BACKGROUND
The use of pediatric donors can increase the number of donors available for pancreas transplantation.


OBJECTIVE
The aim of this study was to verify if pancreas transplantation from pediatric donors is as effective as transplantation from adult donors to restore metabolic control in type 1 diabetic patients.


METHODS
From 2000 to April 2009 we performed 17 pancreas transplantations from pediatric donors: 9 simultaneous kidney-pancreas (SPK), 6 pancreas transplantation alone (PTA), and 2 pancreas after kidney (PAK). All subjects received whole organs with enteric diversion of exocrine secretions; 11 underwent systemic and 6 underwent portal venous graft drainage. The immunosuppressive therapy was as follows: prednisone, mycophenolate mofetil, anti-thymocyte globulin (ATG), and cyclosporine or tacrolimus. The pediatric donor population had a mean age of 15.3 years (range, 12-17), a mean weight of 60.1 kg (range, 42-75), and a mean body mass index (BMI) of 21 (range, 17.9-23.4).


RESULTS
After 9 years the overall patient survival rate was 94.12%, whereas the graft survival rate was 63.35%. Normal glucose and insulin levels were maintained either fasting or during oral glucose tolerance test (OGTT). The group of recipients of pediatric organs was compared with patients receiving organs from adult donors (n = 125); the mean glucose values were lower in the pediatric group, whereas insulin production was higher in the adult patients. Early venous thrombosis was 17.6% in the pediatric group and 20% in adult recipients (Fisher exact test, P = not significant [NS]).


CONCLUSIONS
Pediatric donors restored insulin independence in adult diabetic recipients, representing a valid source of organs for pancreas transplantation.
Socci
C
C
Department of Surgery, Scientific Institute S. Raffaele, Milan, Italy. socci.carlo@hsr.it
Orsenigo
E
E
Santagostino
I
I
Caumo
A
A
Caldara
R
R
Parolini
D
D
Aldrighetti
L
L
Castoldi
R
R
Frasson
M
M
Carvello
M
M
Ghirardelli
L
L
Secchi
A
A
Di Carlo
V
V
Staudacher
C
C
D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000601:surgery*; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007328:Insulin / Q000097:blood / Q000378:metabolism; D000078790:Insulin Secretion; D016381:Islets of Langerhans Transplantation / Q000276:immunology / Q000379:methods / Q000401:mortality / Q000502:physiology*; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D016035:Pancreas Transplantation / Q000276:immunology / Q000379:methods / Q000401:mortality / Q000502:physiology*; D015996:Survival Rate; D016559:Tacrolimus / Q000627:therapeutic use; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*
D001786:Blood Glucose; D007166:Immunosuppressive Agents; D007328:Insulin; D009173:Mycophenolic Acid; D016559:Tacrolimus