ABSTRACT
Although the pancreas was the first extrarenal organ to be used from living donors (LDs) (1), of the more than 18,000 pancreas transplants performed since the 1960s, fewer 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 as compared with deceased 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 deceased donor organ or for uremic diabetics on the simultaneouspancreas-kidney (SPK) waiting list. Before 1994, our institution only offered LD pancreas transplants as either a solitary pancreas transplants alone (PTA) or a pancreas-after-kidney (PAK) transplant because of the fear that multi-organ retrieval from LDs 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 undergo an SPK transplant with its attendant prolonged waiting time. Furthermore, although 43% of patients with end-stage renal disease (ESRD) are diabetic, only 28% undergo a kidney transplant (5). Some data suggest that diabetic patients on dialysis have increased morbidity and mortality rates as compared with nondiabetics on dialysis. The twoand three-year mortality rates of diabetics on dialysis are 17% and 27%, respectively, as compared with 8% and 14% for nondiabetics over the same period (5). Consequently, we now perform LD SPK transplants to decrease morbidity and mortality for patients waiting for an SPK deceased donor.
