Segmental pancreatic transplantation: donor and recipient operation
L. H. Toledo-Pereyra and V. K. Mittal
Although the role of pancreatic transplantation in halting the progression
of the secondary complications of insulin-dependent diabetes has not been
completely defined, the application of segmental pancreatic transplantation
for treatment of juvenile diabetes has increased. Five patients with
insulin-dependent, nonuremic diabetes and definite evidence of progression
of other secondary complications underwent segmental pancreatic
transplantation (donor and recipient operations) with cyanoacrylate duct
occlusion. No evidence of pancreatic function was seen in the first case
because of ischemic and perfusion damage. The four other cases showed
immediate normal pancreatic response after grafting. Several weeks
thereafter, rejection appeared; no reversal was obtained despite
antilymphoblast globulin or corticosteroid treatment. Rejection and
pancreatitis remained the two most important obstacles in successful
pancreatic transplantation. Modifications in the current immunosuppressive
regimen might allow for prolonged pancreatic transplant survival.