Segmental live donor pancreas transplantation: review and critique of rationale, outcomes, and current recommendations

We herein review and comment rationale, outcomes, and current recommendations for live donor (LD) pancreas transplantation (PTx). Segmental (spleen-preserving) pancreas donation is associated with a relatively small risk of complications. The risk of death, presumably not lower than that of LD nephrectomy, cannot be estimated yet because of the lack of reported donor fatalities. The prevalence of type 2 diabetes, in non-obese donors, is expected not to exceed 3%. The risk of type 1 diabetes does not seem to increase. Segmental LD PTx, when compared to cadaver PTx, continues to carry a slightly higher risk of technical failure, but the rate of immunologic failure is consistently lower. Overall, LD PTx should be considered in all patients with a live kidney donor (owing to the shortage of cadaver kidneys, the superlative outcome of LD kidney transplantation, and the immunologic advantages of simultaneous pancreas-kidney transplantation from the same donor). The immunologic advantages of LD PTx are emphasized in highly sensitized recipients of solitary PTx who, with cadaver donation, wait the longest time and face the poorest outcome. Furthermore, LD allows recipient pre-conditioning and/or pair donor exchange. In conclusion, LD PTx may offer significant advantages to well-selected diabetic recipients. LDs are exposed to relatively small risks.