Pancreas transplantation: clinical considerations.

The number of pancreas transplants performed and the success rate have increased significantly since the first segmental pancreas transplant was performed in 1966. Since 1977, 716 pancreas transplants have been performed in 670 patients at 69 institutions. Currently 230 grafts (32 per cent) are listed as functioning (insulin independent). The present 1-year actuarial graft and survival rates at the University of Minnesota are 43 and 88 per cent, respectively. The indications for pancreas transplantation and the selection of recipients have undergone modification, and more nonuremic nonkidney transplant patients are now receiving pancreas allografts. A variety of techniques have been used for pancreas transplantation. Whole or segmental pancreas grafts have been used. Most centers drain the graft exocrine secretions into the gastrointestinal tract as a Roux-en-Y pancreaticojejunostomy or into the bladder as a pancreaticocystostomy. The most common complications requiring radiologic evaluation and treatment include vascular thromboses utilizing technetium flow studies and arteriography and intra-abdominal fluid collections and infections requiring ultrasonography and CT scans. Percutaneous aspiration of intra-abdominal fluid collections is important for diagnosis but has not been successful therapeutically. Intra-abdominal infections are most common in patients with enteric drainage of the pancreas graft, which carries a high risk of contamination at the site of anastomosis. Most intra-abdominal infections require surgical drainage and removal of the graft.