In a new study, doctors at the University of Maryland Medical Center have shown that pancreas transplants alone can be as successful as combined pancreas/kidney transplants. The improved success rate is due to advances in preventing organ rejection and a better method of determining early rejection of the pancreas. The study is published in the October 7 issue of Annals of Surgery.
"This has enormous significance for long-term diabetic patients who are having complications, but not kidney failure," says Stephen T. Bartlett, M.D., director of the Division of Transplant Surgery at the University of Maryland Medical Center.
"Since there has been a large difference in the success rates, many patients have been told to wait until their kidneys failed before considering transplantation. Now, we can effectively treat their diabetes earlier with a transplant, and prevent further complications," says Bartlett, professor of surgery and medicine at the University of Maryland School of Medicine and lead author of the study.
Using a combination of two new anti-rejection drugs, Prograf and Cellcept, the researchers achieved a one-year pancreas survival rate of 77 percent for patients in their study.
Nationally, the one-year success rate of combined pancreas/kidney transplants is 76 percent, but only about 50 percent of the pancreases transplanted without a kidney are still functioning after one year. That success rate for pancreas-alone transplants has remained constant over the past decade.
The prospective study involved 27 pancreas-alone transplant patients who received the two new anti-rejection drugs and needle biopsies of the pancreas if rejection was suspected. After one year, 77 percent of the transplanted organs were functioning. That compares to a success rate of 53.4 percent among 15 pancreas transplant patients in the study who took an older anti-rejection drug, cyclosporine. Also part of the study was a group of 113 patients who received a simultaneous pancreas/kidney transplant and had a one-year organ function rate of 84 percent.
"We found that patients thought to have early signs of rejection could safely have needle biopsies of pancreatic tissue on an outpatient basis, to confirm whether rejection was taking place. That information is important so that therapy can start early to stop the rejection," says Dr. Bartett. He adds that the biopsies also prevent people who are not having rejection from receiving unnecessary therapy.
Under Dr. Bartlett's leadership since 1991, the University of Maryland Medical Center's organ transplant program has grown to one of the busiest in the nation, which performs not only pancreas and kidney transplants but also liver, lung, and heart transplants. Dr. Bartlett performed Maryland's first successful simultaneous pancreas/kidney transplant and the state's first pancreas-alone transplant.
The pancreas, located in the abdomen, is part of the digestive system. It produces insulin, the hormone needed to control sugar levels in the blood. People with long-term insulin-dependent diabetes are at risk of serious complications, including kidney failure, vision and heart problems, and nerve damage. After a successful pancreas transplant, patients no longer need to take insulin shots and they usually do not suffer from further diabetes-related complications.
People who receive pancreas-alone transplants can fall into two categories. They may be suffering from serious complications caused by diabetes, yet they do not have kidney failure. Or, they previously had kidney failure and received a kidney transplant without a new pancreas.