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Pancreas-kidney transplant successful in diabetics.

Pancreas/Kidney Transplant Successful in Diabetics

Ten of twelve insulin-dependent diabetics with kidney disease who received a combined kidney and pancreas transplant are alive and free of insulin or dialysis nearly one year after the procedure, according to a report from Massachusetts General Hospital and Harvard Medical School in Boston.

Prior to the operation, the transplant recipients all had kidney disease as a result of their diabetes, and all required dialysis treatments to control their problem. The researchers selected these patients for the combined transplant because previous research indicated that a kidney transplant alone has poor long-term chances of survival in a diabetic (because the same problem that causes the original kidney's deterioration -- lack of insulin production by the pancreas -- will not have been solved and cardiovascular and kidney complications will occur again).

The researchers also noted that many transplant recipients are reluctant to undergo a second transplant once they have recovered from the first one, and that the cost of two separate operations is much greater than that of the single, combined transplant procedure. Two of the patients died after the procedure, the researchers said -- one from a rupture at a site of the surgical connections, the other from infections that resulted from the immunosuppressive drug he had been taking to prevent his body from rejecting the transplant -- but the remainder are doing well and have normal insulin levels and kidney function. "We have shown that [kidney-pancreas] transplantation can be performed successfully, that such transplantation provides normal glucose metabolism, and that this can be accomplished with only a modest increase in risk over that of renal transplantation alone," the investigators said.

In the conclusion of their study, reported in the May issue of "Archives of Surgery," they proposed that the procedure now be offered to diabetics with "early but not distinctly impaired" kidney function who are not yet dependent on dialysis. "We anticipate that the combined procedure at this earlier stage might be effective in delaying or preventing the progression of secondary [kidney] complications," they said.
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Publication:Nutrition Health Review
Date:Jan 1, 1989
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