Benefits and limitations of pancreas transplantation in insulin-dependent diabetics: a study apropos of 26 patients

From November 1990 to March 1995, 26 simultaneous pancreas-kidney (SPK) transplants were carried out. The recipients were uremic type I diabetic patients. After the first year of transplantation, patient survival was 96% and pancreas and kidney survival was 69% and 84%, respectively. The pancreas transplant failure was due to veinous thrombosis (two cases), and to graft rejection (71%). The most common urologic complications of bladder drainage were urethritis (61%), bicarbonate loss (42%) and urinary tract infections (100%). Fasting blood glucose (0.91 +/- 0.1 g/L), hemoglobin A1C (5.3 +/- 0.4%) and lipidic profile were found to be normal among diabetic recipients whose grafts had been functioning for 1 year. The insulin secretion of type I diabetic patients with SPK transplants (n = 13), and six non diabetic patients with kidney transplants was assessed by oral glucose tolerance tests. Only the patients with SPK transplants presented late hyperinsulinemia at 120 minutes. The quality of life for both type I diabetic patients after SPK transplants and diabetics treated by insulinotherapy (n = 6), was studied. After transplantation, the quality of life improved only because of insulin independence. In spite of chirurgical and urologic complications, pancreas transplantation in type I diabetic patients improves both metabolic control and quality of life.