Currently, 25-30 pancreas transplantations per year are carried out in type 1 diabetes (T1D) recipients residing in Czech Republic. Most of the recipients are transplanted together with kidney allografts, but pancreas is also transplanted alone in selected patients with brittle diabetes. Since 2005, the Institute for Clinical and Experimental Medicine (IKEM) islet transplant program was initiated as complementary therapeutic modality. The aim of this paper was to analyze the transplant program at our clinical center, and to examine the survival of recipients, and their pancreas, kidney, and islet grafts. Patient and graft survival rates were evaluated in the following three categories using Kaplan-Meier test: simultaneous pancreas and kidney transplantation (SPKTx), pancreas transplantation alone (PTA), and islet transplantation (ITx). Three hundred and ninety SPKTx, 34 PTA and 44 ITx were carried out between 1983 and 2010. One- and 5-year patient survival rates were 92 % and 81% in SPKTx, respectively. In SPKTx, the 1-year survival rate of pancreas grafts was 78%, and the 5-year rate was 66%. Kidney graft survival rates were 89% and 79%, respectively, after the same follow-up periods. In the PTA category, recipient survivals were 100% after 1 year, and 92% after 3 years. 70% and 65% of pancreatic grafts were working properly at 1 and 3-year follow-ups, respectively. To date, we have carried out 44 islet transplantations in 31 recipients. Islet function (C-peptide ≥ 0.2 ng/ml) was documented in 60% of recipients after 12 months. So far, only 3 patients remained free of exogenous insulin. While SPKTx is a well established treatment for uremic T1D patients, ITx represents an emerging complementary treatment modality. The latter is especially suitable for high-risk recipients, but routine clinical application is still hampered by the limited availability of usable organ transplants and viability of transplanted islets.

Diabetes Center Institute for Clinical and Experimental Medicine Prague 14300 Czech Republic

Zobrazit více v PubMed

Bartos V, Vanek I. Pancreatic transplantation in Czechoslovakia. Transplant Proc. 1987;19(4 Suppl 4):84–85. PubMed

Saudek F, Adamec M, Bartos V, Vlasakova Z, Boucek P, Koznarova J, Jirkovska A, Vitko S. Transplant therapy for end-stage diabetic nephropathy in a single centre. Transplant Proc. 1997;29(7):3120. PubMed

Saudek F, Adamec M, Ekberg H, Koznarova R, Boucek P, Bartos V. First experience with combined pancreatic-renal transplantation with extraperitoneal placement of the whole pancreatic graft. Transplant Proc. 1995;27(6):3080–3081. PubMed

Girman P, Lipar K, Koznarova R, Boucek P, Kriz J, Kocik M, Havrdova T, Adamec M, Saudek F. Similar early complication rate in simultaneous pancreas and kidney recipients on tacrolimus/mycophenolate mofetil versus tacrolimus/sirolimus immunosuppressive regimens. Transplant Proc. 2010;42(6):1999–2002. PubMed

Boucek P, Saudek F, Adamec M, Janousek L, Koznarova R, Havrdova T, Skibova J. Spectral analysis of heart rate variation following simultaneous pancreas and kidney transplantation. Transplant Proc. 2003;35(4):1494–1498. PubMed

Boucek P, Havrdova T, Voska L, Lodererova A, He L, Saudek F, Lipar K, Adamec M, Sommer C. Epidermal innervation in type 1 diabetic patients: a 2.5-year prospective study after simultaneous pancreas/kidney transplantation. Diabetes Care. 2008;31(8):1611–1612. PubMed PMC

Koznarova R, Saudek F, Sosna T, Adamec M, Jedinakova T, Boucek P, Bartos V, Lanska V. Beneficial effect of pancreas and kidney transplantation on advanced diabetic retinopathy. Cell Transplant. 2000;9(6):903–908. PubMed

Perosa M, Boggi U, Cantarovich D, Robertson P. Pancreas transplantation outside the USA: an update. Curr Opin Organ Transplant. 2011 In press. PubMed

Gruessner AC, Sutherland DE. Pancreas transplant outcomes for United States (US) cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR) Clin Transpl. 2008;2008:45–56. PubMed

Gruessner AC, Sutherland DE, Gruessner RW. Pancreas transplantation in the United States: a review. Curr Opin Organ Transplant. 2010;15(1):93–101. PubMed

Gruessner AC. 2011 Update on Pancreas Transplantation: Comprehensive Trend Analysis of 25,000 Cases Followed Up Over the Course of Twenty-Four Years at the International Pancreas Transplant Registry (IPTR) Rev Diabet Stud. 2011;8(1):6–16. PubMed PMC

Gruessner AC, Sutherland DE. Pancreas transplant outcomes for United States (US) and non-US cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR) as of June 2004. Clin Transplant. 2005;19(4):433–455. PubMed

Ishibashi M, Ito T, Sugitani A, Furukawa H, Sekiguchi S, Gotoh M, Teraoka S, Sato Y, Matsuno N, Kenmochi S. et al. Present status of pancreas transplantation in Japan - donation predominantly from marginal donors and modified surgical technique: report of Japan pancreas transplantation registry. Transplant Proc. 2008;40(2):486–490. PubMed

Perosa M, Crescentini F, Noujaim H, Mota LT, Branez JR, Ianhez LE, Ferreira G, de Oliveira RA, Genzini T. Over 500 pancreas transplants by a single team in Sao Paulo, Brazil. Clin Transplant. 2011 In press. PubMed

Boggi U, Amorese G, Marchetti P. Surgical techniques for pancreas transplantation. Curr Opin Organ Transplant. 2010;15(1):102–111. PubMed

Allen RD, Al-Harbi IS, Morris JG, Clouston PD, O'Connell PJ, Chapman JR, Nankivell BJ. Diabetic neuropathy after pancreas transplantation: determinants of recovery. Transplantation. 1997;63(6):830–838. PubMed

Navarro X, Sutherland DE, Kennedy WR. Long-term effects of pancreatic transplantation on diabetic neuropathy. Ann Neurol. 1997;42(5):727–736. PubMed

Nathan D. Sustained effect of intensive treatment of type 1 diabetes mellitus on development and progression of diabetic nephropathy: the Epidemiology of Diabetes Interventions and Complications (EDIC) study. JAMA. 2003;290(16):2159–2167. PubMed PMC

Increase in lumbar spine but not distal radius bone mineral density in adults after pancreas kidney transplantation

Benefits of Islet Transplantation as an Alternative to Pancreas Transplantation: Retrospective Study of More Than 10 Ten Years of Experience in a Single Center