Pancreatic transplantation using the duct occlusion technique.

Since 1979, the Munich Group has gathered experience with 100 consecutive pancreas transplants using the duct occlusion technique. At the present time, 40 of the pancreas grafts (44%) and 56 of the renal grafts (65%) of 90 patients who received both a pancreas and a kidney are still functioning. The mortality rate of 18% in the early period was relatively high. In the period from 1984 until 1988--using the simple transplantation technique--only one patient died. During this period, our overall results improved with the use of a modified surgical technique and different immunosuppressive and anticoagulative measures along with better patient selection. Normalization of the glucose metabolism seems to improve the rate of late diabetic complications. The duct occlusion technique in isolated pancreas transplants might have been a disadvantage in accounting for the poor results. With regard to metabolic studies, there is now ample evidence to suggest that successful pancreatic transplantation leads to complete normalization of glucose metabolism including normoglycemia in more than 70% of all patients. In addition, clinical data are accumulating that suggest successful pancreatic transplantation has a beneficial effect on the late secondary syndrome of Type I diabetes mellitus.