Imaging in Pancreas and Intestinal Transplantation

Abstract

Successful pancreas transplantation is currently the only known therapy that establishes an insulin-independent euglycemic state with normalization of glycosylated hemoglobin levels. Insulin-secreting cells are part of the pancreatic islets, which are predominantly located in the tail (Williams 1995). In the majority of cases, pancreas transplantation is performed together with the kidney from the same donor as simultaneous pancreas-kidney transplantation in patients with coexisting end-stage diabetic nephropathy, and less frequently as sequential pancreas after kidney transplantation or pancreas transplantation alone. In all modifications of pancreas transplantation the recipient’s native pancreas is left untouched. The first human pancreas transplantation was performed at the University of Minnesota in 1966 (Kelly et al. 1967). Since then, pancreas graft survival has improved consistently, especially in the last decade, thanks to refined surgical techniques and the introduction of better immunosuppressive regimens including tacrolimus and mycophenolate mofetil, which have decreased technical and immunological failure rates. In total, over 90% of pancreas transplantations are performed as simultaneous pancreas-kidney transplantations from the same donor, with the remaining cases classified as sequential pancreas after previous kidney transplantation, and rarely as pancreas transplantation alone. Today the international pancreas transplant registry reports a 1-year patient survival rate of greater than 95%, a 1-year pancreas graft survival rate of greater than 80% for simultaneous pancreas-kidney transplantation, and of nearly 80% for pancreas after previous kidney transplantation and pancreas transplantation alone (Gruessner and Sutherland 2001; International Pancreas Transplant Registry 2004). Although the majority of transplant centers formerly used exocrine bladder drainage to divert pancreatic juice, an increasing proportion of simultaneous pancreasûkidney transplantations are being performed with the more physiologic enteric drainage and either systemic or portal endocrine drainage.