ABSTRACT
Although the pancreas was the first extra-renal organ to be used from living donors (LDs) (1), of the greater than 18,000 pancreas transplants performed since the 1960s less than 1% have come from LDs (2,3). Reasons for the underuse of this resource include the potential morbidity of an open distal pancreatectomy in an otherwise healthy donor, and the higher technical failure rate compared to cadaver donor transplants. In selected cases, however, LD pancreas transplantation may be an appropriate option for high panel reactive antibody (PRA) recipients who are unlikely to receive a cadaver organ or uremic diabetics on the simultaneous pancreas-kidney (SPK) waiting list. Prior to 1994, our institution only offered LD pancreas transplants as either solitary pancreas (PTA) transplants or pancreas after kidney (PAK) transplants, because of the fear that multiorgan retrieval from a LD entailed too much morbidity (4). With this approach, however, diabetic uremic recipients would have to endure two separate procedures, which many patients are reluctant to undergo. Patients will often pass up a single organ in order to receive an SPK transplant with its attendant prolonged waiting time. Furthermore, although 43% of patients with end-stage renal disease are diabetic, only 28% receive a kidney transplant (5). There are data to suggest that diabetic patients on dialysis have increased morbidity and mortality rates compared to nondiabetics on dialysis. The two-and three-year mortality rate of diabetics on dialysis is 17% and 27%, respectively, compared to 8% and 14% for nondiabetics over the same period of time (5). Consequently, we now perform LD SPK transplants to decrease morbidity and mortality while waiting for an SPK.
