Indication, selection of XXXX and timing for pancreatic transplantation.

@entity1 @entity8 @entity6 @entity2316 @entity3949 @entity1723 @entity2412
For more than 20 years pancreas transplantation has been advocated as a therapeutic modality in @entity1 with @entity1723 . When successful, this procedure is the only method for attaining long-term normoglycaemia in @entity6 recipients. However, because of the potential morbidity and mortality, pancreas transplantation should be restricted to @entity6 @entity1 in whom the complications of the @entity6 state are more serious than those of surgery and chronic immunosuppression. Currently three recipient categories have been identified in which pancreas transplantation would seem justifiable. The first includes @entity6 @entity1 with end-stage @entity8 who are already obligated to life-long immunosuppressive therapy because of the @entity8 . In this recipient category the main benefit of receiving a pancreas transplant in addition to a kidney is that the quality of life is markedly improved. In addition, it seems that a functioning pancreas transplant prevents the recurrence of @entity2316 in the simultaneously transplanted kidney. Since the success rate with combined pancreas-kidney transplantations is approaching that of renal transplantation alone, there is little controversy about performing the combined procedure in @entity6 @entity1 . However, if the main objective of pancreas transplantation, namely to prevent the late @entity2412 , were to be fulfilled this intervention would have to be performed earlier in the course of the disease. Therefore, single pancreatic transplantations have recently been conducted in @entity6 @entity1 with early signs of clinical @entity8 which, currently, is the most powerful predictor of susceptibility to detrimental @entity6 complications. Preliminary findings indicate that, in this second recipient category, single pancreatic transplantation and subsequent euglycaemia may prevent the progression of @entity3949 and @entity8 ; with regard to @entity6 the results remain obscure.(ABSTRACT TRUNCATED AT 250 WORDS)
