Living-Donor Pancreas Transplantation. Progress, Pitfalls, and Promise.

Pancreas transplants using living donors (LDs) can be done safely and successfully in carefully selected donors and recipients. Worldwide, since 1979, more than 150 LD pancreas transplants have been done; over the last decade, the overall 1-year graft survival rates have exceeded 85%. A meticulous donor workup, per standard evaluation criteria, remains key to a low rate of metabolic and surgical complications in LDs. Such transplants should be considered for (i) candidates with an identical twin or a human leukocyte antigen (HLA)-identical sibling or (ii) candidates with high panel-reactive antibody levels and a suitable LD. The use of LDs decreases the number of deaths of diabetic patients on the waiting list, helps to overcome the organ shortage, reduces mortality and morbidity posttransplant, and improves the quality of life for recipients who, pretransplant, suffered debilitating side effects of diabetes. In addition, the use of LDs (vs. deceased donors) reduces the risk of graft loss from rejection. An LD pancreas transplant remains relatively rare, done under very specific circumstances.