Novel immunosuppression in pancreas transplantation and outcomes

PURPOSE OF REVIEW: Pancreas transplantation continues to evolve and mature offering diabetic patients longer lives with improved quality of life and reduced morbidity. A review of current literature was performed to assess important trends in the care and outcome of patients following pancreas transplantation with and without simultaneous renal transplant. RECENT FINDINGS: Overall results of pancreas transplantation have improved worldwide. Since 1988, 1-year survival pancreas graft survival rates have improved from 75 to 85% for simultaneous kidney-pancreas transplants, 55 to 78% for pancreas after kidney transplants, and 45 to 77% for pancreas transplant alone. Over 80% of pancreas transplant recipients now receive induction therapy. Use of antibody induction has enabled an increase in the use of steroid free maintenance protocols from 4 to 24% of recipients nationwide. Furthermore, a variety of single center protocols, which are both calcineurin inhibitor and corticosteroid free, have recently reported. Finally, there is a growing acceptance of the safety and efficacy of pancreases obtained from donors following cardiac death. SUMMARY: Pancreas transplantation continues to evolve. To maximize benefits to current and future recipients, creative approaches to improve long-term graft survival and increase the organ supply must be evaluated.