Pancreas and islet transplantation for patients with diabetes.

H i s t o r i c a l l y, patients with diabetes have expended tremendous eff o rt in pursuing a re t u rn to norm o g l y c e m i a. The relatively recent results of the Diabetes C o n t rol and Complications Trial (DCCT), demonstrating an approximate 50% re d u c-tion in eye, nerve, and kidney complications in a group of patients re c e i v i n g intensive treatment for hyperglycemia (1), have made this pursuit even more intense. Successful pancreas and islet transplanta-tions are currently the only therapies that re p roducibly achieve normoglycemia by reestablishing endogenous insulin secretion responsive to normal feedback re g u l a-tion. This re p o rt briefly considers the h i s t o ry, techniques, clinical results, and risk-benefit relationship of successful pan-c reas and pancreatic islet transplantations in hyperglycemic patients with long-standing diabetes. — P a n c re a t i c transplantation was first used for the tre a t-ment of type 1 diabetes in humans in 1966 (2). In that early era, the rates of graft and patient survival were low, so very few pro-c e d u res were perf o rmed until 1978. Important steps toward improving surgical re s u l t s included the introduction of impro v e d i m m u n o s u p p ressive regimens, especially the use of cyclosporine and anti–T-c e l l agents, new surgical techniques, and the selection of healthier recipients. In the past decade, the number of pro c e d u res per-f o rmed has steadily increased each year (3). By the end of 1997, nearly 10,000 pan-c reatic transplantations had been re c o rd e d in the International Pancreas Tr a n s p l a n t R e g i s t ry, and in that year alone, more than 1,200 pro c e d u res were re p o rted. The results from diff e rent centers vary depending on operative experience and patient selection. The 1994–1997 data from the I n t e rnational Pancreas Transplant Registry (3) indicate an overall 1-year patient survival rate of 90% (Fig. 1). The 1-year rate of graft survival (defined as total fre e d o m f rom insulin …