Living related donor pancreas and pancreas-kidney transplantation.

Our experience with living related donor (LRD) pancreas transplants shows that they can be performed with low morbidity and mortality for both donors and recipients. The recipient survival rate is 90% at both 1 and 5 years post-transplant. Our overall pancreas graft survival rate is comparable to that for cadaver transplants; if only technically successful cases are included, the graft survival rate is significantly better for LRD (versus cadaver) transplants. Advantages for LRD recipients include fewer rejection episodes, less immunosuppression, lower incidence of graft loss from rejection, and elimination of waiting time. Donor mortality in our series was 0%, and the incidence of surgical complications about 10-15%. LRD pancreas transplants are an attractive option for endocrine replacement therapy in certain diabetic patients. Optimal candidates are: (i) patients who are highly sensitized and have a low probability of receiving a cadaver graft; (ii) patients who should avoid high-dose immunosuppression; (iii) patients with nondiabetic identical twins; and (iv) uremic patients who want one operation with no waiting in order to remain or become dialysis free as well as insulin-independent. These transplants can be performed safely in all recipient categories--pancreas transplant alone, pancreas after kidney or simultaneous pancreas-kidney transplant. In all groups, LRD transplants should be done only when the donor, the recipient, and the entire family understands the advantages and disadvantages of LRD versus cadaver transplants.