Living donor pancreas transplantation

The pancreas was the first extrarenal organ to be successfully transplanted with use of a living donor. The goal at that time, in the azathioprine and cyclosporine eras, was to improve graft survival rates after solitary pancreas transplants. But today, in the tacrolimus era, most living donor pancreas transplants are with a simultaneous living donor kidney transplant because of the cadaver kidney donor shortage. The evolution of stringent selection criteria for living pancreas donors has significantly reduced the incidence of surgical complications and adverse metabolic changes. In contrast to kidney and liver transplants with use of living donors, the donor mortality rate after more than 140 living donor pancreas transplants has remained 0%, The introduction of laparoscopic donor hernipancreatectomy, with its rapid recovery time, makes living pancreas donation more attractive. Patient and graft survival rates for living donor pancreas recipients are now greater than 85%. Living donor pancreas (with or without a simultaneous living donor kidney) transplants decrease the number of deaths of diabetic patients on dialysis and on the waiting list, help overcome the organ shortage, reduce morbidity, and improve the quality of life for patients formerly on dialysis or with debilitating side effects of diabetes. Meticulous donor workup remains key to a low metabolic and surgical complication rate.