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.