Pancreas transplantation

Gut and Liver, Vol. 4, No. 4, December 2010, pp. 450-465

review

Pancreas Transplantation
Duck Jong Han* and David ER Sutherland
†
†

*Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Minnesota, Minneapolis, MN, USA

Department of Surgery, University of

Diabetes mellitus is generally treated with oral diabetic drugs and/or insulin.However, the morbidity and mortality associated with this condition increases over time, even in patients receiving intensive insulin treatment, and this is largely attributable to diabetic complications or the insulin therapy itself. Pancreas transplantation in humans was first conducted in 1966, since when there has been much debate regarding the legitimacy of this procedure. Technicalrefinements and the development of better immunosuppressants and better postoperative care have brought about marked improvements in patient and graft survival and a reduction in postoperative morbidity. Consequently, pancreas transplantation has become the curative treatment modality for diabetes, particularly for type I diabetes. An overview of pancreas transplantation is provided herein, covering thehistory of pancreas transplantation, indications for transplantation, cadaveric and living donors, surgical techniques, immunosuppressants, and outcome following pancreas transplantation. The impact of successful pancreas transplantation on the complications of diabetes will also be reviewed briefly. (Gut Liver 2010;4:450-465) Key Words: Pancreas; Transplantation; Diabetes

INTRODUCTION
Diabetesmellitus is a leading public health concern in oriental countries and around the world. According to the Centers for Disease Control, more than 15 million people in the United States, or 5.9% of the population, have dia1 betes and 798,000 new cases are diagnosed each year.

The prevalence of diabetes in Korea is almost the same with the states as 5.92% of the population. It is estimated that thediabetic population is rapidly increasing 2 by 10% each year. While hyperglycemia is the defining characteristic of diabetes, the underlying pathogenesis leading to hyperglycemia differs significantly among the various forms of the disease. Common to all is the presence of defects in insulin secretion and/or insulin action. Type 1 diabetes occurs when the pancreatic beta cells are destroyed andthe patient develops profound or absolute insulin deficiency. Nearly all cases are autoimmune in origin. This form of diabetes accounts for approximately 5% to 10% of diabetes. The disease most often appears in childhood, but patients of any age may present 3 with type 1 diabetes. A mixture of genetic and environmental factors are believed to lead to the autoimmune destruction that causes type 1diabetes. Over the past 10 4 years the incidence of type 1 diabetes has increased. Type 2 diabetes occurs as the result of defects in both insulin secretion and insulin action. This form of the disease represents about 90% of prevalent cases of diabetes. The incidence of type 2 diabetes in children has been dra5,6 matically increasing in recent years. Diabetes mellitus is associated with devastatingcomplications that increase both the mortality and morbidity of those suffering from the disease. Heart disease is the leading cause of diabetes related deaths and people with diabetes die from heart disease two to four times more often than people without diabetes. This is one of the leading cause of end stage re2 nal disease in Korea.

Correspondence to: Duck Jong Han Department of Surgery,Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap 2-dong, Songpa-gu, Seoul 138-736, Korea Tel: +82-2-3010-3487, Fax: +82-2-474-9027, E-mail: djhan@amc.seoul.kr Received on December 30, 2009. Accepted on March 3, 2010. DOI: 10.5009/gnl.2010.4.4.450

Han DJ, et al: Pancreas Transplantation

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Excessive hyperglycemia is a major risk factor for the development of...