Abstract
The advantages of living donor pancreas transplants for the recipient include good HLA matching, lower immunologic risk, less immunosuppression, lower risk of infection and of posttransplant malignancies, and shorter pancreas graft preservation time. In 2008, a total of 155 segmental pancreas transplants using living donors were reported to the International Pancreas Transplant Registry from six countries. Pancreas living donors need to undergo a thorough pretransplant endocrinologic workup in order to minimize the risk of metabolic complications. The pretransplant workup has evolved over time, after initial reports showed that up to 25% of living donors had elevated hemoglobin A1c levels after donation. Avoiding obesity after donation diminishes the risk of long-term metabolic complications. The risk of surgical complications for the donor (such as pancreatitis, pancreatic leak or fistula, pancreatic abscess, and pancreatic pseudocyst) is less than 5%. If both the donor and recipient operations are technically successful, the long-term graft survival rate is significantly higher for living (versus deceased) donor pancreas transplant recipients. Future long-term studies of metabolic function in living donors are warranted to determine whether living donor pancreas transplants can safely be applied more widely and whether living donors can be used for islet transplants.
Similar content being viewed by others
References
Sutherland DER, Goetz FC, Najarian JS. Living-related donor segmental pancreatectomy for transplantation. Transplant Proc. 1980;12(Suppl. 2):19–25.
Sutherland DER, Goetz FC, Najarian JS. Report of 12 clinical cases of segmental pancreas transplantation at the University of Minnesota. Transplant Proc. 1980;12(No. 4, Suppl. 2):33–9.
Groth CG, Lundgren G, Gunnarsson R, et al. Experience with nine segmental pancreatic transplantations in preuremic diabetic patients in Stockholm. Transplant Proc. 1980;12(Suppl. 2):68–71.
Sutherland DER. Pancreas and islet transplantation. II. Clinical trials. Diabetologia. 1981;20:435–50.
Gruessner RWG, Sutherland DER. Simultaneous kidney and segmental pancreas transplants from living related donors—the first two successful cases. Transplantation. 1996;61:1265–8.
Benedetti E, Dunn T, Massad MG, et al. Successful living related simultaneous pancreas–kidney transplant between identical twins. Transplantation. 1999;67:915–8.
Gruessner AC. Personal communication. IPTR. 10 January 2009.
Gruessner RWG. Living donor pancreas transplantation. In: Gruessner RWG, Sutherland DER, editors. Transplantation of the pancreas, chap 14. New York: Springer; 2004. p. 423–40.
Sutherland DER, Gruessner R, Dunn D, et al. Pancreas transplants from living-related donors. Transplant Proc. 1994;26:443–5.
Gruessner RWG, Najarian JS, Gruessner AC. Pancreas transplants from living related donors. In: Touraine JL, Traeger J, Bétuel H, et al., editors. Organ shortage—the solutions. Dordrecht: Kluwer; 1995. p. 77–83.
Gruessner RW, Burke GW, Stratta R, et al. A multicenter analysis of the first experience with FK506 for induction and rescue therapy after transplantation. Transplantation. 1996;61:261–73.
Gruessner AC, Sutherland DE. Pancreas transplant outcomes for United States (US) and non-US cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR) as of June 2004. Clin Transplant. 2005;19:433–55.
Gruessner RWG. Rationale for living donor pancreas transplants. In: Gruessner RWG, Benedetti E, editors. Living donor organ transplantation, chap 18.2. McGraw-Hill, New York; 2008. p. 383–4.
Gruessner RWG, Sutherland DER, Gruessner AC. Mortality assessment for pancreas transplants. Am J Trans. 2004;4:2018–26.
Gruessner RWG. Should priority on the waiting list be given to patients with diabetes: pro. Transplant Proc. 2002;34:1575–6.
Larson TS, Bohorquez H, Rea DJ, et al. Pancreas-after-kidney transplantation: an increasingly attractive alternative to simultaneous pancreas–kidney transplantation (miscellaneous article). Transplantation. 2004;77:838–43.
Hariharan S, Pirsch JD, Lu CY, et al. Pancreas after kidney transplantation. J Am Soc Nephrol. 2002;13:1109–18.
Gruessner RWG, Kandaswamy R, Denny R. Laparoscopic simultaneous nephrectomy and distal pancreatectomy from a live donor. J Am Coll Surg. 2001;193:333–7.
Tan M, Kandaswamy R, Sutherland DER, Gruessner RWG. Laparoscopic donor distal pancreatectomy for living donor pancreas and pancreas–kidney transplantation. Am J Trans. 2005;5:1966–70.
Horgan S, Galvani C, Gorodner V, Bareato U, Panaro F, Oberholzer J, et al. Robotic distal pancreatectomy and nephrectomy for living donor pancreas–kidney transplantation. Transplantation. 2007;84:934–6.
Gruessner RWG, Kendall DM, Drangstveit MB, et al. Simultaneous pancreas–kidney transplantation from live donors. Ann Surg. 1997;226:471–81.
Gruessner RWG. Morbidity, mortality, and long-term outcome. In: Gruessner RWG, Benedetti E, editors. Living donor organ transplantation, chap 19.3. McGraw-Hill, New York; 2008. p. 398–400.
Kendall DM, Sutherland DER, Najarian JS, et al. Effects of hemipancreatectomy on insulin secretion and glucose tolerance in healthy humans. N Engl J Med. 1990;322:898–903.
Robertson RP. Endocrine function and metabolic outcomes in pancreas and islet transplantation. In: Gruessner RWG, Sutherland DER, editors. Transplantation of the pancreas, chap 15. New York: Springer; 2004. p. 441–54.
Seaquist ER, Robertson RP. Effects of hemipancreatectomy on pancreatic alpha and beta cell function in healthy human donors. J Clin Invest. 1992;89:1761–6.
Seaquist ER, Pyzdrowski K, Moran A, et al. Insulin-mediated and glucose-mediated glucose uptake following hemipancreatectomy in healthy human donors. Diabetologia. 1994;37:1036–43.
Seaquist ER, Kahn SE, Clark PM, et al. Hyperproinsulinemia is associated with increased ß cell demand after hemipancreatectomy in humans. J Clin Invest. 1996;97:455–60.
Robertson RP, Lanz KJ, Sutherland DER, et al. Relationship between diabetes and obesity 9–18 years after hemipancreatectomy and transplantation in donors and recipients. Transplantation. 2002;73:736–41.
Robertson RP, Sutherland DER, Seaquist ER, et al. Glucagon, catecholamine, and symptom responses to hypoglycemia in living donors of pancreas segments. Diabetes. 2003;52:1689–94.
Gruessner RWG, Sutherland DER, Drangstveit MB, et al. Pancreas transplants from living donors: short- and long-term outcome. Transplant Proc. 2001;33:819–20.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Reynoso, J.F., Gruessner, C.E., Sutherland, D.E.R. et al. Short- and long-term outcome for living pancreas donors. J Hepatobiliary Pancreat Sci 17, 92–96 (2010). https://doi.org/10.1007/s00534-009-0147-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00534-009-0147-x