Pancreatico-duodenal and renal allotransplantation in juvenile onset, insulin dependent, diabetes mellitus with terminal nephropathy

Summary

We have developed a technique for allotransplantation of the pancreas in pancreatectomized dogs. This method employs a graft of the whole pancreas and duodenum (P-D) which is placed in a heterotopic position with drainage of exocrine secretions of the grafted pancreas into the recipients jejunum via the graft duodenum. Venous return from the P-D allograft is directed into the systemic rather than the portal venous system. Panereatectomized dogs with such P-D allogrâfts have survived many months if immunosuppressive drugs are given to prevent rejection. We have also found that the P-D graft can survive in vitro without circulation and retain the ability to secrete insulin when stimulated by blood glucose perfusion after as long as 24 h of in vitro preservation. Preservation is done with a chamber which combines hypothermia to 5 °C and hyperbaria to 4 atmospheres of oxygen.

Armed with this knowledge, we have made P-D allografts combined with renal allografts in five patients with insulin dependent, juvenile onset diabetes mellitus with terminal nephropathy. Two of these patients have left the hospital and have normal function of the P-D and renal allografts. Neither patients has required insulin since transplantation, 11 months and 7 months ago. P-D allotransplantation is now planned for insulin dependent, juvenile onset diabetics who have significant but not terminal nephropathy or retinopathy.

If P-D allotransplantation is found to slow, cause to regress, or prevent the vascular deterioration characteristic of diabetes mellitus, then it may become the most frequent organ transplant because of the increasing incidence of diabetes mellitus.