Pancreatic transplantation: the Cambridge experience.

In contrast to heterotopic pancreas transplantation and conventional insulin therapy the paratopic positioning of a segmental pancreas graft provides physiological endocrine hormone delivery into the portal venous circulation. Metabolic studies performed on previously insulin dependent diabetic patients with renal failure with functioning paratopic pancreas transplants and heterotopic kidney grafts from the same donor showed near normal day to day glucose control with normal fasting glucose levels and normal HbA1 values. Hyperinsulinaemia was not seen in these patients. The effect of denervation of the pancreatic graft on the entero-insular axis and its influence on the islets were investigated. The incretin effect was preserved indicating a significant hormonal stimulation of the entero-insular axis.