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A. Benedict Cosimi, MD; Hugh Auchincloss, Jr, MD; Francis L. Delmonico, MD; Leslie Fang, MD; David M. Nathan, MD; Nina Tolkoff-Rubin, MD; Robert H. Rubin, MD; Harold C. Yang, MD; Paul S. Russell, MD

Arch Surg. 1988;123(5):621-625.

Abstract
• Kidney and pancreaticoduodenal transplantation were simultaneously performed in 12 insulin-dependent diabetic patients. These patients had advanced secondary complications, including blindness, vascular disease, and disabling neuropathy. Average posttransplant hospitalization and charges were 17.7 days and $42 780 compared with 11.2 days and $29 000 for patients who received renal allografts alone. Following transplantation, blood glucose and glycosylated hemoglobin A levels promptly returned to normal in all patients. Two patients subsequently died, one after five months of a cytomegalovirus infection and one after seven months of a ruptured bladder. After a mean of 11.6 months of follow-up, ten patients (83%) remained independent of insulin and dialysis. The success of pancreas transplantation in diabetics with advanced complications now approaches that of other organ allografts. It therefore appears reasonable to recommend transplantation for diabetics with less severe secondary complications, since these candidates are most likely to realize the potential benefits of long-term normoglycemia.

(Arch Surg 1988;123:621-625)

Author Affiliations
From the Transplantation Unit, Massachusetts General Hospital (Drs Cosimi, Auchincloss, Delmonico, Fang, Nathan, Tolkoff-Rubin, Rubin, Russell, and Yang), and the Departments of Surgery (Drs Cosimi, Auchincloss, Delmonico, Russell, and Yang) and Medicine (Drs Fang, Nathan, Tolkoff-Rubin, and Rubin), Harvard Medical School, Boston.

Footnotes
Accepted for publication Jan 27, 1988.

Read before the Annual Meeting of the New England Surgical Society, Bretton Woods, NH, Sept 11, 1987.

Reprint requests to Department of Surgery, Massachusetts General Hospital, Boston, MA 02114 (Dr Cosimi).

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