| [ Summary ] |
Pancreas transplantation is broadly accepted as the best treatment strategy for insulin dependent diabetes mellitus(IDDM) with end-stage renal failure. Simultaneous pancreas/kidney transplantation is a standard operation, because of the high graft survival rates compared to other pancreas transplantations (pancreas transplantation after kidney transplantation or pancreas transplantation alone). The one year patient survival rate after pancreas/kidney transplantation is 94% That is significantly higher than the survival rate of 35% for diabetic patients on maintenance hemodialysis therapy in United States. Pancreas transplantation alone is indicated for unstable plasma glucose control, with severe fatal hypoglycemia and IDDM with early sign of diabetic nephropathy, to prevent the progression of diabetic nephropathy to endstage renal failure. Preoperative evaluation of systemic cardiovascular disease and latent infectious diseases is essential to prevent postoperative patient death, due to coronary disease and fatal infection and to achieve successful pancreas transplantation. Only three patients have received simultaneous pancreas/kidney transplantation after the implementation of the organ transplantation law in Japan. On the other hand, the annual number of pancreas transplantation is approximately 1,200 in the United States. |