Combined kidney and pancreas transplantation in diabetics

A. B. Cosimi, H. Auchincloss Jr, F. L. Delmonico, L. Fang, D. M. Nathan, N. Tolkoff-Rubin, R. H. Rubin, H. C. Yang and P. S. Russell
Transplantation Unit, Massachusetts General Hospital, Boston 02114.

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.