[Pancreatic transplantation. Experience at the University of Barcelona]. / Trasplate de páncreas. Experiencia de la Universidad de Barcelona.

OBJECTIVES: To present the experience of the University of Barcelona with simultaneous transplantation of the kidney and pancreas. METHODS: From February, 1983 to September, 1995, we have performed 112 simultaneous kidney and pancreas transplants at the University of Barcelona. Significant changes were made in 1989 relative to the surgical technique, immunosuppression and diagnosis of rejection, consequently the patients have been divided into two groups for analysis: patients treated from 1983 to 1988 (period A) and patients treated from 1989 to 1995 (period B). In both groups we analyzed patient and graft survival, morbidity, effects of SKP transplantation on glucose metabolism, diabetic complications and quality of life. RESULTS: Patient, kidney and pancreas survival rates were 62.50%, 52.94% and 23.52%, respectively for period A and 86.88%, 82.40% and 71.65% for period B. The metabolic study performed in patients with pancreas functioning for more than one year showed glucose and glycosylated hemoglobin values similar to those of the normal population, although the baseline insulin values were higher (24 +/- 15vs 12 +/- 1 mv/l, p 0.01). The course of retinopathy and visual acuity was better in patients with functioning kidney and pancreas than in the control group. Some aspects of quality of life, such as overall perception of health and physical activity were better in patients with functioning kidney and pancreas than in the control group. CONCLUSION: The results of simultaneous kidney and pancreas transplantation have improved significantly in recent years and it is currently the best therapeutic option for patients with type 1 diabetes and end-stage renal disease.

[Pancreas transplant]. / Trasplante de páncreas.

Pancreas transplantation offers the possibility of preventing the development and progression of diabetic lesions by adequate control of hydrocarbon metabolism. Moreover, the diabetic patient is freed from dietary and physical restrictions, as well as from insulin treatment. However, this is achieved at the expense of an immunosuppression not always free of risk. For this reason, up to now, the transplantation has been reserved to those patients at a risk higher than that of immunosuppression: uremic patients who also require a kidney transplantation, patients suffering of preproliferative retinopathy, and those patients with urine protein above 150 mg/24 hours but less than 3 g/24 hours. The introduction of cyclosporine has greatly improved the transplantation results, achieving a 53% actuarial survival of the graft per year. Out of the different technics used, the one that yields best results is the transplantation of the whole organ, deriving the exocrine secretion to the urinary bladder. This method also enables early diagnosis of graft rejection by monitoring urine amylase.