Pancreas transplantation--the Detroit experience (Mount Carmel Mercy Hospital).

In our preliminary series of pancreas transplants, the best results were obtained when kidneys were transplanted with pancreas allografts. The use of CyA together with combined kidney and whole pancreas transplants has significantly improved the graft survival in our program. It is difficult to draw conclusions as to the best technique for ductal management with the limited number of patients in each group. However, in our experience, ductocystostomy and pancreaticoduodenocystostomy have so far yielded the best results. Pancreaticocutaneous fistula with delayed ductal occlusion yielded the worst results and is not recommended. The effect of pancreas transplantation on the secondary complications may not be well discerned at this point in time until more long-term survivors are obtained. Some of our current results reflect the acceptance of high-risk transplant candidates into our program as well as the search for an improved pancreatic drainage technique.