Pancreatic whole organ transplantation.

Transplantation of the whole pancreas can produce normal glucose homeostasis and there is evidence that a functioning allograft is capable of arresting or even perhaps reversing the vascular changes of diabetes. The technical complications of necrosis, bleeding, and perforation of the transplanted duodenum and disruption of the duodenalenteric anastomosis can all be managed by immediate removal of the allograft at the first sign of rejection. While there is increasing evidence that islet cells are more violently rejectedly in the human than are some other transplanted tissues, it is not clear whether this is true with the organ pancreas transplant. The four relatively long-term successes of organ pancreas transplants in the human would suggest that the organ transplant may act more like a kidney transplant than do islet cells. In the author's opinion, many of the problems may be technical, and carefully controlled, staged whole or partial pancreas allografts in the human still hold promise for ultimate better long-term success.