Journal of Clinical & Experimental Nephrology

Editorial Note

Pancreas transplantation is typically performed on people who have type 1 diabetes and have end-stage renal disease, brittle diabetes, or hypoglycaemia unawareness. A pancreas transplant, on the other hand, can help some type 2 diabetics. Clotting of the new pancreas' arteries or veins (thrombosis), inflammation of the pancreas (pancreatitis), infection, bleeding, and rejection are all possible complications right after surgery. Rejection might happen immediately or at any point throughout the patient's life. Because the transplanted pancreas is from a different organism, the patient's immune system will perceive it as a threat and attempt to fight it. Organ rejection is a dangerous disorder that requires quick attention. Immunosuppressive medicines must be taken by patients in order to prevent it. Drugs are usually commonly used in combination, with ciclosporin, azathioprine, and corticosteroids being the most common. However, because episodes of rejection might recur throughout a patient's life, the exact immunosuppressant options and dosages may need to be adjusted over time. Tacrolimus is sometimes used instead of ciclosporin, while mycophenolate mofetil is sometimes used instead of azathioprine.

A pancreas transplant is the sole option for patients with type 1 diabetes who have severe, regular hypoglycemia but adequate kidney function. PTA, or pancreatic transplantation, has recently been showing remarkable results. Only the pancreas of a donor is given to the recipient in this kind of pancreas transplantation, which is the least common.

Simultaneous Pancreatic-Kidney transplantation occurs when the pancreas and kidneys are transplanted from the same deceased donor at the same time (SPK). The most common pancreatic transplant procedure is this one. End-stage renal disease and type 1 diabetes are both indications for an SPK (with other diabetic complications like neuropathy, gastroparesis etc.) The most prevalent form of pancreatic transplantation is this one. The main reason for this is that most patients are already on immunosuppressive drugs, and adding kidneys to the mix lessens the risk of surgery.

When a cadaveric, or deceased, donor pancreatic transplant is performed after a preceding, and different, living or deceased donor kidney transplant, it is known as Pancreas-After-Kidney transplant (PAK). After a successful kidney transplant, this procedure is frequently advised for diabetic patients. The disadvantage of this surgery is that patients must undergo surgical risk twice.

SPLK (Simultaneous deceased donor Pancreas and Live donor Kidney) has a lower rate of delayed graft function and shorter waiting times than SPK, resulting in better outcomes.

After pancreatic transplantation, the prognosis is excellent. Long-term effectiveness has improved in recent years, while hazards have decreased. More than 95 percent of all patients are still alive one year following transplantation, and 80-85 percent of all pancreases are still functional. Patients must be immunosuppressed for the rest of their lives after transplantation. Immunosuppression increases the risk of infection and cancer in a variety of ways.

Newer advancements in transplant processes have made it possible to overcome some of the existing obstacles, such as donor shortages and immunological reactions that lead to rejection. Immune rejection was a downside of using porcine islet cells to create xenoislets for transplantation. Human embryonic stem cells and generated pleuripotent stem cells are being studied extensively to see if they may develop into functional insulin-producing cells. This could lead to the successful transplantation of such cells.

Islet encapsulation is another form of transplantation that protects against immunological responses. Isolated human islets or porcine xenoislets are encased in a semipermeable barrier that allows nutrients and hormones to pass through while preventing cell interaction with immune cells and therefore protecting against immunological reactions. To reduce the loss of transplanted islet cell mass in the post transplant period, several novel medicines are being tested. Efforts are being made to increase islet graft efficacy while minimizing immunosuppressive treatment effects.