Pancreas Transplantation

Insulin-dependent diabetes mellitus is a common disorder with at least 100 000 new cases identified worldwide each year. Fifteen to 20 years later, approximately half of these patients will have developed the devastating microangiopathic complications of the disease despite reasonable control of hyperglycemia by currently available medical regimens. Since extensive experimental evidence suggests this dismal prognosis can be averted only by uninterrupted scrupulous control of both hyperglycemic and hypoglycemic episodes, replacement of the patients' inadequate insulin delivery system by transplantation has been pursued as an attractive therapeutic approach for nearly 25 years.

Until recently, the success rate following pancreas transplantation was so marginal that attempts to develop the procedure were properly limited to a handful of investigators particularly interested in the field. Now, however, more acceptable survival rates are achievable because of refinements in the surgical aspects of the procedure and advances in immunosuppressive management of allograft recipients. This has