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Q: Are pancreas transplants very successful for someone who has had a previous successful kidney transplant? I have been considering a pancreas transplant, but several doctors have told me the success rates are not that good and that, in some cases, the individual develops a milder form of diabetes.
San Antonio, Texas
A: I always look at questions like this by asking, "What are your options?"
In the case of a pancreas transplant alone, it is necessary to weigh the risks of anti-rejection drug therapy against those of diabetes. In your case, you have already assumed the risks of anti-rejection drug therapy in order to maintain the healthy function of your transplanted kidney. Now you must decide whether or not to continue with the risks and inconveniences of diabetes.
The International Pancreas Transplant Registry (IPTR) reports that more than 15,000 pancreas transplants were done between 1966 and 2000 and that almost 100 hospitals now perform the procedure in the United States. Almost every kidney transplant program in the United States offers pancreas transplants to kidney recipients who have diabetes. Medicare has covered simultaneous pancreas/kidney transplants since 1998.
Between 1987 and 2000, the success rates for pancreas transplants after kidney transplants increased from 52 to 76 percent. This improvement coincided with the refinement of surgical techniques and the addition of new anti-rejection drugs. Elevated blood glucose can occur when the body is unable to respond adequately to the demand for extra insulin induced by anti-rejection drugs. The risk of drug-induced hyperglycemia is about 5 percent for pancreas recipients, which is somewhat lower than the risk in kidney-only recipients. Given your options, it sounds like even the possibility of transplant drug-induced hyperglycemia that would need treatment may be a better option than the aggressive diabetes that caused your kidneys to fail in the first place.
Insulin-Free World Foundation
St. Louis, Missouri
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