Pancreas transplantation.

Between December, 1966 and October, 1981, 183 pancreas transplants were performed in attempts to correct the metabolic defect in 171 insulin-dependent diabetic patients. Nearly half of the transplants have been performed in the last two years. Currently, 20 patients have functioning grafts and are insulin independent. Twelve grafts (including six current ones) functioned for more than a year (the longest for four years). A variety of techniques have been used to drain or suppress the secretions of the exocrine pancreas; the most frequent method is injection of the pancreatic duct with a synthetic polymer. In most patients carbohydrate metabolism has been normal or nearly normal while the graft was functioning. Although the technical problems are not entirely solved, the major cause of graft failure has been rejection. The need for antirejection therapy has limited the application of pancreas transplantation to diabetic renal allograft recipients or to non-uraemic patients whose complications of diabetes are, or predictably will be, worse than the side- effects of chronic immunosuppression. If consistently effective methods to suppress the immune response of the recipient to donor histocompatibility antigens are developed, pancreas transplantation could be applied to a wider variety of diabetic patients.