An update on pancreatic transplantation.

The number of pancreatic transplants and the success rate have continued to increase. Most pancreatic transplants have been placed in diabetic recipients of renal transplants with end-stage renal disease, but application to nonuremic patients not undergoing renal transplants is increasing. Drainage of the graft duct into the bladder allows direct assessment of exocrine function and leads to earlier diagnosis and treatment of rejection episodes. There has been an improvement in graft survival rates associated with the use of cyclosporine in combination with other immunosuppressants. The effect of successful pancreatic grafts on the specific complications of diabetes is just beginning to be discerned, but a salutary effect appears to occur if the transplant is performed sufficiently early in the course of the disease.