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Sammanfattning

Thirty-seven years after the first transplantation, pancreas transplantation is the type of organ transplantation that has increased the most over the last years, now accounting for approximately 2,000 transplants per year. The best candidates for receiving a pancreas graft are patients with type 1 diabetes mellitus who need a renal transplant due to end-stage diabetic nephropathy. The procedure can be performed as simultaneous kidney-pancreas transplantation or as pancreas transplantation after kidney transplantation. In rare cases isolated pancreas transplantations are performed in patients with brittle diabetes, especially in patients with nonawareness of hypoglycaemia. The results of pancreas transplantation have improved considerably over the last decade. This is due mainly to improvement of immunosuppression after the introduction of mycophenolate mofetil and tracrolimus. Another factor is the development of fine-needle biopsy from the pancreas graft as a form of routine investigation. One-year transplantation survival for combined kidney-pancreas transplantation is currently better than 90%, slightly lower for isolated pancreas transplantation. Randomised studies of the effect of pancreas transplantation are not available, but even so there is solid evidence that the diabetic recipients of a kidney transplantation live longer and enjoy a better quality of life if they have a functioning pancreas transplantation. Furthermore, there is convincing evidence that these patients' risk of new diabetic complications is reduced or eliminated by a pancreas transplantation. In many patients, there is also a diminution of existing diabetic complications. On this basis, the authors advocate that diabetic recipients of a kidney transplantation should also be considered for pancreas transplantation.

MeSH