Pancreas Transplants for Diabetics Seen as Risky

A pancreas transplant has long been considered the gold standard for treatment of patients with diabetes, but a new study says those who undergo the procedure are more than 50% more likely to die during the first four years after the operation.

The study did not address either long-term survival or quality of life considerations, however, and some diabetologists predicted that many patients would continue to undergo the surgery to free themselves from multiple daily injections of insulin and frequent finger pricks for monitoring blood sugar.

Isolated pancreas transplants are relatively rare, but their numbers have been increasing recently, from 37 in 1995 to 141 in 2002, according to the study. Transplant surgeons have historically argued that the benefits of receiving a pancreas, which produces insulin in the body, do not justify subjecting the patient to the strong immunosuppressive drugs required for a transplant.

The procedure is performed more commonly on patients who have already undergone a kidney transplant as a result of their diabetes and are thus already taking the drugs. About 900 pancreas transplants are performed each year either simultaneously with a kidney transplant or later.

A team led by Dr. Jeffrey M. Venstrom of the National Institute of Diabetes and Digestive and Kidney Diseases compared the survival of patients receiving both types of transplants to that of comparable patients on waiting lists for a transplant.

Among patients receiving only a pancreas, 96.5% survived one year and 85.2% survived four years, compared with 97.6% and 92.1% for those on the waiting list. Among those who received both a kidney and a pancreas, 95.3% survived one year and 84.5% survived four years. They reported their results in the latest issue of the Journal of the American Medical Assn.