Pancreas transplantation is primarily performed in type I juvenile onset diabetes mellitus(DM). At present the patients selected for transplantation often have complications such as end-stage renal disease, neuropathy and far advanced retinopathy. These days, the survival of pancreas transplantation for treatment of patients with type I DM has improved especially in simultaneous pancreas and renal transplantation. Various innovations in immunosuppression, management of the pancreatic exocrine secretion, recipient selection and HLA matching have contributed to achieving a reasonable outcome in pancreatic transplantation compared with other organ transplantations. Current improved graft survival has stimulated many centers in the world to become interested in pancreas transplantation program. We successfully performed the first case of simultaneous pancreas and kidney transplantation in our country in August 1992. Until now, 14 cases of pancreas transplantation have been performed in 3 centers, including our 12 cases.
Diabetes Mellitus, Type 1 ; Graft Survival ; Humans ; Immunosuppression ; Kidney Failure, Chronic ; Kidney Transplantation ; Organ Transplantation ; Pancreas Transplantation* ; Pancreas* ; Transplantation ; Transplants

Impaired awareness of hypoglycemia has been found to be prevalent in 20% to 40% of people with type 1 diabetes. If a similar prevalence exists in Koreans with type 1 diabetes, at a minimum, thousands of people with type 1 diabetes suffer at least one unpredicted episode of severe hypoglycemia per year in Korea. For patients with problematic hypoglycemia, an evidence-based stepwise approach was suggested in 2015. The first step is structured education regarding multiple daily injections of an insulin analog, and the second step is adding a technological intervention, such as continuous subcutaneous insulin infusion or real-time continuous glucose monitoring. The next step is a sensor-augmented pump, preferably with a low glucose suspension feature or very frequent contact, and the final step is islet or pancreas transplantation. In Korea, however, none of these treatments are reimbursed by the National Health Insurance, and thus have not been widely implemented. The low prevalence of type 1 diabetes means that Korean physicians are relatively unfamiliar with the new technologies in this field. Therefore, the roles of new technologies and pancreas or islet transplantation in the treatment of problematic hypoglycemia need to be defined in the current clinical setting of Korea.
Education ; Glucose ; Humans ; Hypoglycemia* ; Insulin ; Islets of Langerhans Transplantation ; Korea* ; National Health Programs ; Pancreas ; Pancreas Transplantation ; Prevalence

INTRODUCTION: Islet cell transplantation is an attractive alternative to whole organ pancreas transplantation, because it is clearly the safer and simpler surgical procedure for recipients. PURPOSE: The authors intended to examine the functional outcome of islet autografting and the factors related to islet graft survival in mongrel dogs. METHODS: Eighteen adult mongrel dogs were used for the study of total pancreatectomy and islet autotransplantation. The harvested total pancreas was preserved in iced Hank's balanced salt solution (HBSS). The islets were properly isolated by a modified Recordi method. RESULTS: The median volume of the transplanted pancreatic islet tissue was 2.1 mL (range 0.7 to 5.0) and purity was 63% (range 10 to 95). Twelve dogs from the experimental group having undergone successful autografting of islets were followed for a minimum of 6 weeks. Three of the 12 dogs maintained insulin secretory function for 6 weeks and the other 7 dogs showed normal Kg values for 6 months following islet transplantation. In the remaining 2 cases, islet graft function was sustained for 1 year. The median required insulin dosage for maintenance of normal FPG was 0.7 U/kg per day (range 0 to 1.6). The insulin requirement correlated well with the IEq/ kg level (r=.90, P<.01). Dogs with >6,000 IEq/kg had a better chance of being insulin-independent. CONCLUSION: In this study, we confirmed that autotransplantation of islet cells on pancreatectomized dogs can render nearly normoglycemia, and islet transplantation dogs can be used as a model for the assessment of insulin secretory function.
Adult ; Animals ; Autografts* ; Dogs ; Graft Survival ; Humans ; Insulin ; Islets of Langerhans Transplantation ; Islets of Langerhans* ; Pancreas ; Pancreas Transplantation ; Pancreatectomy ; Transplantation, Autologous ; Transplants

Pancreas transplantation is the most effective cure for type I diabetes because it is able to restore normal glucose homeostasis. Over the last 2 decades, improvements in immunosuppressive therapy have been paralleled by a marked decrease in surgical complications, by superior antimicrobial prophylaxis and therapy, and by better techniques for diagnosing and treating pancreas graft rejection. The result has been a steady increase in the number of pancreas transplants. However, differently from heart, lung and liver transplantation, pancreas transplantation cannot be considered a life-saving procedure and the advantages in the long term should be carefully considered and balanced with the morbidity and mortality associated to the surgical procedure and the side-effect of immunosuppression.
Glucose ; Graft Rejection ; Heart ; Homeostasis ; Immunosuppression ; Islets of Langerhans Transplantation ; Korea ; Liver Transplantation ; Lung ; Pancreas ; Pancreas Transplantation ; Transplants

Transplantation of whole pancreas has emerged as an effective treatment modality for patients with diabetes mellitus, especially those with established end-stage renal disease. Although surgical and immunosuppressive advances have significantly improved allograft survival over a sustained period of time, there has been significant risk of surgical and post-operative complications. Islet transplantation has been considered as an attractive treatment option due to its less invasiveness and reduced peri-procedure morbidity, and because it can improve glycemic control in the type 1 diabetic patient with hypoglycemic unawareness. However, the revived enthusiasm regarding clinical islet transplantation after the landmark Edmonton trial has been decreased by the long-term results, although recent advances have led to an increased rate of achieving and maintaining insulin independence after islet transplantation. The aim of this review is to summarize current status and the outcome of whole pancreas and islet transplantation and their impact on patient's survival and long-term diabetic complications in patients with type 1 diabetes.
Diabetes Complications ; Diabetes Mellitus ; Humans ; Insulin ; Islets of Langerhans Transplantation ; Kidney Failure, Chronic ; Pancreas ; Pancreas Transplantation ; Transplantation, Homologous ; Transplants

Transplantation of whole pancreas has emerged as an effective treatment modality for patients with diabetes mellitus, especially those with established end-stage renal disease. Although surgical and immunosuppressive advances have significantly improved allograft survival over a sustained period of time, there has been significant risk of surgical and post-operative complications. Islet transplantation has been considered as an attractive treatment option due to its less invasiveness and reduced peri-procedure morbidity, and because it can improve glycemic control in the type 1 diabetic patient with hypoglycemic unawareness. However, the revived enthusiasm regarding clinical islet transplantation after the landmark Edmonton trial has been decreased by the long-term results, although recent advances have led to an increased rate of achieving and maintaining insulin independence after islet transplantation. The aim of this review is to summarize current status and the outcome of whole pancreas and islet transplantation and their impact on patient's survival and long-term diabetic complications in patients with type 1 diabetes.
Diabetes Complications ; Diabetes Mellitus ; Humans ; Insulin ; Islets of Langerhans Transplantation ; Kidney Failure, Chronic ; Pancreas ; Pancreas Transplantation ; Transplantation, Homologous ; Transplants

Pancreas transplantation is the best option for the cure of insulin dependent diabetes. Simultaneous pancreas kidney transplantation (SPK), pancreas transplantation alone (PTA), or pancreas transplantation after kidney transplantation (PAK) is performed according to the renal failure status. The best survival result comes from SPK. Donor selection is much more important than the type of transplantation since the purpose of transplantation is mainly to improve quality of life and poor quality pancreas may result in severe life threatening complications. In the majority of pancreas transplantations, systemic venous drainage is performed and this does not seem to increase the risk of atherosclerosis. Bladder drainage of exocrine secretion may result in several side effects and is not frequently performed in SPK recently. With the development of good immunosuppression regimen, the patient and graft survival rates have improved. Pancreas transplantation should be considered for the insulin dependent diabetes patients who meet the inclusion criteria.
Atherosclerosis ; Donor Selection ; Drainage ; Graft Survival ; Humans ; Immunosuppression ; Insulin ; Kidney Transplantation ; Pancreas Transplantation* ; Pancreas* ; Quality of Life ; Renal Insufficiency ; Urinary Bladder

No abstract available.
Humans ; Immunosuppression ; *Kidney Transplantation/methods ; *Pancreas Transplantation/methods ; Patient Selection ; Treatment Outcome

Pancreas transplantation has became an accepted form of therapy for insulin dependent DM (IDDM). However, rejection remains the major cause of graft loss in pancreas allografts. To overcome the immunologic graft loss following pancreas allograft, early reliable method for rejection is crucial. The purpose of this study was to evaluate the significance of urine amylase (UA) levels as a reliable and sensitive indicator of pancreas allograft rejection retrospectively. Over a 15-month study period from August '97 to Cotover '98, 9 pancreas transplants with bladder drainage were performed at our center. Among which 6 pancreas transplantation alone (PTA) and 3 simultaneous pancreas-kidney transplantation (SPK) were performed. The diagnosis of rejection was based on clinical criteria (fever, tenderness, leukocytosis) and serology such as, a reduction in UA level. Rejection was developed in 5 patients (56%), including 4 PTA and 1 SPK recipients. Mean UA level during normal allograft function was 89,365 U/L, whereas level heralding rejection was 14,760 U/L (P<0.05). After steroid pulse therapy, first rejection episode result in 100% reversal of rejection and the UA level returned toward normal (mean 95,437 U/L). However more than one rejection episode resulted in poor outcome (all the graft were lost). Overall, reversal of rejection occurred in 63% of cases, with 2 PTA and 1 SPK lost due to rejection. Monitoring pancreas-allograft function by UA allows for the timely diagnosis and successful treatment of pancreas-allograft rejection. For more than one rejection episodes, more potent immunosuppressants are through needed to be improve the graft survival.
Allografts* ; Amylases* ; Diagnosis ; Drainage ; Early Diagnosis* ; Graft Survival ; Humans ; Immunosuppressive Agents ; Insulin ; Pancreas Transplantation* ; Pancreas* ; Retrospective Studies ; Transplants ; Urinary Bladder

Diabetes mellitus is generally treated with oral diabetic drugs and/or insulin. However, the morbidity and mortality associated with this condition increases over time, even in patients receiving intensive insulin treatment, and this is largely attributable to diabetic complications or the insulin therapy itself. Pancreas transplantation in humans was first conducted in 1966, since when there has been much debate regarding the legitimacy of this procedure. Technical refinements and the development of better immunosuppressants and better postoperative care have brought about marked improvements in patient and graft survival and a reduction in postoperative morbidity. Consequently, pancreas transplantation has become the curative treatment modality for diabetes, particularly for type I diabetes. An overview of pancreas transplantation is provided herein, covering the history of pancreas transplantation, indications for transplantation, cadaveric and living donors, surgical techniques, immunosuppressants, and outcome following pancreas transplantation. The impact of successful pancreas transplantation on the complications of diabetes will also be reviewed briefly.
Cadaver ; Diabetes Complications ; Diabetes Mellitus ; Graft Survival ; Humans ; Illegitimacy ; Immunosuppressive Agents ; Insulin ; Living Donors ; Pancreas ; Pancreas Transplantation ; Postoperative Care ; Transplants