Post Pancreas Transplant Manual of Therapeutics

Introduction

Pancreas transplantation has progressed from the laboratory experimental model through the clinical era of low graft survival to the present where this option represents a very, rational and economical alternative for individuals with Type I diabetes. Unfortunately, pancreas transplantation is still thought of in the clinical realm as overly complex with poor survival. Patient survival has always been equivalent to other transplant procedures, approximating 92 percent at one year. Many in the medical field recall historical pancreas graft survival rates of approximately 50 percent. The most recent data reveals that with maturation of the procedure graft survival has improved to 74 percent with some programs, such as our own, having graft survival rates in the 80-90 percent range. Negative stigmatas associated with pancreas transplantations were the prolonged hospital courses, frequent complications, and that horrific case that many remember as a resident. Just as survival rates have improved, the efficiency of pancreas transplantation has also improved. Average lengths of stays following the transplant procedures are now fifteen days in many institutions with re-admission rates in the first year of 60-70 percent for a total re-hospitalization of five days. The Rush Program has found that by utilizing enteric drainage of the pancreas graft significant improvements have been realized in lengths of stays, quality of life, re-admission rates and complications. However, we are still not perfect, and therefore there is the need for this manuscript.

More than 5,000 pancreas transplants have been performed. With the increased success rates it would not be unusual for the clinicians to find that a patient who has received a pancreas transplant is included in their practice. Many clinicians approach transplant patients, and especially the pancreas transplant patient, with hesitance because the perception that these patients represent an overwhelmingly complex medical creation. They do have specific issues that need to be understood and taken into consideration when planning a choice of therapy, but the overall management of the patient is not remarkably different. The following are some guidelines to be considered in caring for the pancreas transplant patient. It is a hope that this manuscript will act as a readily available reference when you are confronted with a pancreas transplant patient. You should also be reassured that the pancreas transplant programs are readily available to work with you in your care for these patients.