Pancreas Transplantation From Living Donors

The pancreas was the first extrarenal organ that was successfully transplanted using a living donor. Since 1979, about 200 living donor pancreas transplants have been performed worldwide. Pancreas transplants from living donors have been done in all 3 recipient categories: initially solitary transplants only (PTA, PAK) and, since 1994, in combination with a living donor kidney (SPK). SPK transplants from living donors were the first living donor dual organ transplants of any kind. From the donor perspective, the surgical principles of distal pancreatectomy for the purpose of living donor pancreas transplantation include preservation of blood supply via the splenic vessels, gentle parenchymal dissection, and preservation of the spleen. The (distal) pancreas was also the first extra-renal solid organ that was successfully procured from a living donor using the minimally invasive (laparoscopic) technique. Living pancreas donors must undergo thorough metabolic testing pre-donation to minimize the risk of developing diabetes post-donation. Strict exclusion criteria have been developed and reduced the rate of post-donation diabetes. No living donor deaths have been reported for distal donor pancreatectomy. From the recipient perspective, advantages of living (vs. deceased) donor pancreas transplantation include elimination of waiting time, shorter preservation time, and, in case of a biological donor, better HLA matching, lower immunologic risk, and less immunosuppression. Living donor grafts are preferentially implanted intraabdominally on the right side using enteric (or bladder) drainage for pancreatic exocrine secretions and systemic venous drainage Improvements in immunosuppressive and anticoagulatory protocols have resulted in 1-year graft survival rates of > 85% for living donor pancreas recipients. The field of living donor pancreas transplantation has fundamentally contributed to our understanding of Type 1 diabetes: recurrence of autoimmune disease with selective beta cell destruction and isletitis was diagnosed first in living donor grafts of identical twins. Living donor pancreas transplants are an option if the recipient (1) is highly sensitized (PRA > 80%) and has a low probability of receiving a deceased donor graft; (2) must avoid high-dose immunosuppression; (3) has a nondiabetic identical twin or a 6-antigen-matched sibling; (4) and wants to preempt dialysis (if uremic). Pancreas transplants using living donors can be done safely and successfully in selected donors and recipients.