Minnesota experience with 85 pancreas transplants between 1978 and 1983.

We have performed 85 pancreas transplants in 79 diabetic patients since 1978 in a new clinical trial. Fifty grafts were from cadaver donors (32 segmental, 18 whole organ) and 35 (segmental) were from related donors (4 parent, 17 HLA identical and 7 non-identical siblings, 6 identical twins, 1 cousin). All the grafts from the living related donors were immediately transplanted, but 48% of the cadaver donor grafts were stored at 4°C in silica gel-filtered plasma for an average of 11.4 hours. Of the 67 recipients with HLA-DR typing, 27% were DR3, 30% were DR4, and 39% were DR3,4 (96% for one or both). Fifty-five percent of the recipients had had functioning renal allografts from 6 to 9 months earlier, while 45% were not renal recipients who had serum creatinine levels < 2.5 mg/100 ml and had not been previously immunosuppressed. Of the 75 patients transplanted, 62 (83%) are alive and 23 (32%) are insulin independent ranging from 1 to 65 months after transplant. The 1-year actuarial graft survival rate is 25% overall, 36% from related and 16% from cadaver donors. Thirteen (17%) of the 75 have been insulin independent for more than 1 year. Graft failure resulted from technical error in 22 (26%) [10 from vascular problems, 4 (open duct) from severe ascites, 3 from peritonitis, 2 (pancreatico-jejunostomy) from pancreatic leaks, and 3 from inadequate preservation]. Thirteen patients died (5 with functioning grafts): 6 from infections, 4 from cardiovascular disease, 1 from hyperkalemia, 1 from anaphylaxis to ALG, and 1 from unknown causes as a sudden death at home. One of the unresolved problems is that of the optimal technique to handle exocrine drainage. Of the 3 duct-ligated grafts, all failed technically, and the 4 prolamine-injected grafts had no long-term function. Of the 15 open-duct grafts, 53% were technical failures with 3 currently functioning. Of the 28 pancreatic-jejunal grafts, 29% failed technically with 13 functioning from 1 to 28 months. Of the 35 silicone-injected grafts, 9% technically failed with 7 currently functioning from 3 to 36 months. The 35 living related pancreatic donors have shown 2 (6%) to develop abnormal glucose tolerance tests, 2 (6%) to acquire complications requiring additional surgical correction, and 1 (3%) to show a nonoperative pancreatic complication. We favor cyclosporine A over azathioprine but the results must be individualized. Questions regarding autoimmune recurrence of disease are also raised by our studies in identical twins.