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Continuing Education in Anaesthesia, Critical Care & Pain Advance Access originally published online on August 22, 2005
Continuing Education in Anaesthesia, Critical Care & Pain 2005 5(5):149-152; doi:10.1093/bjaceaccp/mki040
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Continuing Education in Anaesthesia, Critical Care & Pain | Volume 5 Number 5 2005 © The Board of Management and Trustees of the British Journal of Anaesthesia [2005]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Anaesthesia for pancreas transplantation

A C Pichel, MB ChB FRCA, Specialist Registrar in Anaesthesia
Department of Anaesthesia, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL

W R Macnab, MB ChB BSc FRCA, Consultant Anaesthetist
Department of Anaesthesia, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL
Tel: 01612 764551/2, Fax: 01612 768027. E-mail: ross.macnab{at}cmmc.nhs.uk (for correspondence)

Diabetes mellitus is a leading cause of morbidity and mortality in the western world. Approximately 9% of the NHS budget is spent on diabetes and its complications. Although improvements in insulin therapy have taken place, morbidity is still a reality for many patients. The only way to achieve tight glucose control is by using a closed loop system, whereby insulin levels are adjusted according to the needs of the patient on a minute by minute basis. There are two methods to achieve this: (i) continuous glucose monitoring and an insulin infusion; and (ii) pancreas transplantation.

The first pancreas transplant took place in the USA on December 16, 1966.3 Since then, over 19 000 transplants have been reported to the International Pancreas Transplant Registry (IPTR), 14 000 of them being performed in the USA.4 Pancreas transplantation brings about insulin independence. It has also been shown to halt the progression of diabetic nephropathy in native kidneys. The kidney of those undergoing simultaneous pancreas and kidney transplantation (SPK) does not develop diabetic nephropathy in the donor grafts after successful surgery. There have also been improvements in retinopathy and neuropathies associated with type 1 diabetes. There are three main categories of pancreas transplantation: (i) SPK; (ii) pancreas after kidney (PAK); and (iii) pancreas alone transplant (PAT). The most common operation by far is the SPK. Analysis of US data from the IPTR shows pancreas graft survival rates of 85% for SPK, 77% for PAK and 73% for PAT.4 The improvements on earlier data are mainly attributable to better patient selection, lower technical failure and lower immunological failure rates.1 The 1 yr patient survival rates are over 94% in all groups.4


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