Pancreatic transplantation in patients with type-I diabetes: the experience in Maastricht with a new model.

A successful pancreatic transplant together with a kidney graft makes type-I diabetic patients with end-stage diabetic nephropathy independent from insulin and dialysis. Several surgical techniques for the pancreatic graft are employed. Major problems are thrombosis of the graft and the handling of the exocrine secretion of the pancreas. A transplant model is presented that reduces the risk of thrombosis by including the spleen in the graft. The exocrine secretion is handled by transplanting a segment of duodenum with the graft and by connecting this segment to the recipient's bladder. Experience has been gained in four patients. All are insulin-independent. Severe complications have not been observed, which makes this model suitable for further assessment of the effect of pancreatic transplantation on the course of type-I diabetic patients.