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The United States Experience

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Transplantation of the Pancreas

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Abstract

The pancreas was the first extra-renal organ to be successfully transplanted using a living donor. Since 1979, 137 living donor pancreas transplants have been performed in the United States, most of them at the University of Minnesota. Pancreas transplants from living donors have been done in all 3 recipient categories: initially solitary transplants only (PTA, PAK) and, since 1994, in combination with a living donor kidney (SPK). SPK transplants from living donors were the first living donor dual organ transplants of any kind. The (distal) pancreas was also the first extra-renal solid organ that was successfully procured from a living donor using the minimally invasive (laparoscopic) technique. Advantages of living (vs. deceased) donor pancreas transplantation include elimination of waiting time, shorter preservation time, and, in case of a biological donor, better HLA matching, lower immunologic risk, and less immunosuppression. The greatest challenge is the selection of suitable volunteers who have sufficient beta cell mass to stay nondiabetic post-donation. This has resulted in substantial changes in metabolic criteria over time. Improvements in immunosuppressive and anticoagulatory protocols have resulted in 1-year graft survival rates of >85% for living donor pancreas recipients. The field of living donor pancreas transplantation has fundamentally contributed to our understanding of Type 1 diabetes: recurrence of autoimmune disease with selective beta cell destruction and isletitis was diagnosed first in living donor grafts of identical twins. Living donor pancreas transplants are an option if the recipient (1) is highly sensitized (PRA >80%) and has a low probability of receiving a deceased donor graft; (2) must avoid high-dose immunosuppression; (3) has a nondiabetic identical twin or a 6-antigen-matched sibling; (4) and wants to preempt dialysis (if uremic). Pancreas transplants using living donors can be done safely and successfully in selected donors and recipients.

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Authors and Affiliations

  1. Department of Surgery, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USA

    Rainer W. G. Gruessner

  2. Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA

    Angelika C. Gruessner

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  1. Rainer W. G. Gruessner
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  2. Angelika C. Gruessner
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Correspondence to Rainer W. G. Gruessner .

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  1. Department of Surgery, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USA

    Rainer W. G. Gruessner

  2. Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA

    Angelika C. Gruessner

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Gruessner, R.W.G., Gruessner, A.C. (2023). The United States Experience. In: Gruessner, R.W.G., Gruessner, A.C. (eds) Transplantation of the Pancreas. Springer, Cham. https://doi.org/10.1007/978-3-031-20999-4_38

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  • DOI: https://doi.org/10.1007/978-3-031-20999-4_38

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  • Print ISBN: 978-3-031-20998-7

  • Online ISBN: 978-3-031-20999-4

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