The history of Pancreas Transplantation: Past, Present and Future

Abstract. The first attempt to cure type 1 diabetes by pancreas transplantation was done at the University of Minnesota, in Minneapolis, on December 17, 1966, followed by a series of whole pancreas transplantation. Due to the lack of potent immunosuppressive drugs, rejections and infections, it was concluded that pancreas was less antigenic than the kidney
which was less antigenic than the duodenum. It opened the door to a period, between the mid 70’s to mid 80’s where
only segmental pancreatic grafts were used in the recipient. Numerous techniques for diverting or dealing with the pancreas
juice secretion were described, none of them being satisfactory. In the late 70’s – early 80’s, three major events
happened and boosted the development of pancreas transplantation : firstly the introduction of Cyclosporine A in the
clinical field, secondly the organization on March 1980, of the first international meeting on Pancreas Transplantation
with the first report of the International Pancreas Transplantation Registry (IPTR) and finally in 1982, the organization
of the first informal so-called Spitzingsee meetings where pancreas transplantation successes but mainly failures were
discussed which precluded the onset of IPITA (International Pancreas and Islet Transplantation Association), EuroSPK
(European Study Group for simultaneous Pancreas and Kidney Transplantation) and EPITA (European Pancreas and
Islet Transplantation Association).
During one of the Spitzingsee meetings, participants had the idea to renew the urinary drainage technique of the exocrine
secretion of the pancreatic graft with segmental graft and eventually with whole pancreaticoduodenal transplant. That
was clinically achieved during the mid 80’s and remained the mainstay technique during the next decade. In parallel, the
Swedish group developed the whole pancreas transplantation technique with enteric diversion. It was the onset of the
whole pancreas reign. The enthusiasm for the technique was rather moderated in its early phase due to the rapid development
of liver transplantation and the need for sharing vascular structures between both organs, liver and pancreas.
During the modern era of immunosuppression, the whole pancreas transplantation technique with enteric diversion
became the gold standard for simultaneous pancreas and kidney transplantation (SPK), with portal drainage of the
venous effluent of the pancreas, even for pancreas after kidney (PAK) or pancreas transplantation alone (PTA).
Today, there remains room for improvement : safety of using the duodeno-duodenal anastomosis technique must be
confirmed by prospective analysis while preventing ischemic reperfusion injuries, using specific drugs ; that must be
assessed in new trials.