PANCREAS AND ISLET CELL TRANSPLANTATIONS IN MAN

The limitations of insulin therapy explain the growing interest expressed by diabetologists in pancreas and islet cell transplantations. Pancreatic graft is the most used method, and its technique is now well established; the exocrine secretion can be either dried up by pancreatic duct obstruction or drained, often into the bladder. However, this method demands permanent immunosuppression and for this reason it is used in 85 percent of the cases in diabetics requiring kidney transplantation. The mortality and morbidity due to transplantation have decreased considerably. The survival rate at 1 year is 81 percent for patients and 46 percent for grafts, with return to normal glycaemia levels in most cases. The effects of pancreas transplantation on diabetic microangiopathy are difficult to evaluate in these patients who often have very advanced complications, but the first data are encouraging. The indications for this transplantation are limited, and they should not be extended to early stage diabetes unless they are part of controlled studies. Islet cell transplantation has many potential advantages, including safety and the hope of grafts without permanent immunosuppression, but the results available in man are still very preliminary.