The effects of pancreas and kidney transplantation on diabetic complications vary widely. "Pancreas transplantation can effectively restore endogenous insulin secretion in type 1 diabetes mellitus, and prevent, retard, or reverse diabetic complications," writes J. W. de Fijter, MD, Department of Nephrology, Leiden University Medical Centre.
In the case of simultaneous pancreas and kidney transplantation, consideration must be given to the fact that most patients who receive a pancreas in combination with a kidney graft, do so after having been diagnosed with diabetes for 20 years or more, notes the investigator.
However, potential benefits should always be balanced against the risk of preoperative morbidity. Immunosuppressive therapy will also have to be prescribed for a long period of time with complications of its own.
At present, the only reliable option to achieve long-term normoglycaemia is through whole pancreas transplantation. Ultimately, pancreatic islets transplantation will succeed only if transplanted islets can survive for a considerable period of time.
This will require the development and use of new immunosuppressive drugs with a toxicity profile that will not interfere with the longevity of the islets. Nevertheless, recurrent autoimmune destruction of transplanted pancreatic ß-cells will have to be prevented if the technique is to succeed, concludes the author. Neth J Med 2004 Mar;62:3:71-5
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