title: Expanding the indications of pancreas transplantation alone.
abstract: OBJECTIVE
  Total pancreatectomy (TP) is associated with postoperative endocrine and exocrine insufficiency. Especially, insulin therapy reduces quality of life and may lead to long-term complications. We review the literature with regard to the potential option of pancreas transplantation alone (PTA) after TP in patients with chronic pancreatitis or benign tumors.
  
  
  METHODS
  A MEDLINE search (1958-2013) using the terminologies pancreas transplantation, pancreas transplantation alone, total pancreatectomy, morbidity, mortality, insulin therapy, and quality of life was performed. In addition, the current book and congress publications were reviewed.
  
  
  RESULTS
  Total pancreatectomy after benign and borderline tumors as well as chronic pancreatitis is continuously increasing. Despite improvement of exogenous insulin therapy, more than 50% of these patients experience severe glucose control problems, which cause up to 50% long-term mortality. Pancreas transplantation alone can cure both endocrine and exocrine insufficiency and reduce the associated risks. The 3-year graft and patient survival rates after PTA are up to 73% and 100%, respectively.
  
  
  CONCLUSIONS
  Pancreas transplantation alone after TP in patients with pancreatitis or benign tumors improves the recipient's quality of life and reduces long-term mortality. Considering the amount of available organs and potential candidates, PTA can be a treatment option for patients after TP with chronic pancreatitis or benign tumors.
authors.affiliation: From the *Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany; †Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran; and ‡Department of Nephrology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Arianeb
authors.initials: A
authors.lastname: Mehrabi
authors.forename: Mohammad
authors.initials: M
authors.lastname: Golriz
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Adili-Aghdam
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Hafezi
authors.forename: Maryam
authors.initials: M
authors.lastname: Ashrafi
authors.forename: Christian
authors.initials: C
authors.lastname: Morath
authors.forename: Martin
authors.initials: M
authors.lastname: Zeier
authors.forename: Thilo
authors.initials: T
authors.lastname: Hackert
authors.forename: Peter
authors.initials: P
authors.lastname: Schemmer
mesh_terms: D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000191:economics / Q000209:etiology / Q000601:surgery; D010188:Exocrine Pancreatic Insufficiency / Q000209:etiology / Q000601:surgery; D014943:Global Health; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007328:Insulin / Q000191:economics / Q000627:therapeutic use; D016381:Islets of Langerhans Transplantation / Q000191:economics; D016035:Pancreas Transplantation / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D010180:Pancreatectomy / Q000009:adverse effects; D010190:Pancreatic Neoplasms / Q000601:surgery; D050500:Pancreatitis, Chronic / Q000601:surgery; D011183:Postoperative Complications / Q000191:economics / Q000401:mortality / Q000523:psychology / Q000601:surgery; D011788:Quality of Life; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014850:Waiting Lists
chemical_list: D007166:Immunosuppressive Agents; D007328:Insulin