Pancreas Transplantation for Pancreatic Sufficiency
A 47-year-old man presented with pancreatic insufficiency after several episodes of ethyl alcohol pancreatitis. His renal function is still normal but is getting worse. He needs subcutaneous insulin oral and pancreatic enzymes. He has no other disease. Is he a candidate for pancreas transplantation alone (PTA)?

Andre I. David, MD

The current indications for PTA are a history of frequent, severe metabolic complications (especially severe hypoglycemic unawareness) requiring medical attention and consistent failure to control blood sugars despite intensive management. In most centers, the presence of significant secondary complications is also needed to be considered for PTA.

In general, chronic kidney disease is a contraindication for PTA because of the fact that the immunosuppressive regimen (cyclosporine or tacrolimus) may worsen kidney function. A creatinine clearance above 60 mL/minute is the minimum clearance to be considered for PTA.

The results for PTA are improving, but the 3-year-graft survival is only slightly better than 60%. One needs to also consider the risk of mortality associated with the procedure and the need for chronic immunosuppression.

For these reasons, I do not believe that the patient you describe is a candidate for PTA. He has chronic kidney disease that may be progressive. If the he develops end-stage renal disease, he would certainly be a candidate for a combined kidney-pancreas transplantation.