University of Nebraska physicians and researchers report on their experience with 62 consecutive cases of solitary pancreas transplantation in the March 1997 issue of Diabetes Care. The researchers report that, of the 32 pancreas-kidney transplants performed in Nebraska, there was a 100% patient, kidney and pancreas graft survival at 1 year and a 97% patient survival and 91% kidney and pancreas graft survival at 5 years. Following this success, they undertook solitary pancreas transplants. From March 1991 through Feb 1996, they performed 62 consecutive solitary pancreas transplants (20 sequential pancreas-after-kidney in 19 patients and 42 pancreas-alone in 38 patients) in 57 adult TypeI patients, consisting of 31 men and 28 women, with a mean age of 38 (range 25-62) and mean duration of diabetes of 26 years (range 14-52). Patients were all prescreened and selected based on degree of nephropathy, cardiovascular risk and presence of diabetic complications: indications for the solitary pancreas transplant were 2 or more overt diabetic complications and/or glucose hyper- lability with hypoglycemia unawareness and impaired quality of life plus adequate renal and cardiac reserve. Patients over age 65, actively smoking, with an ejection fraction less than 40%, with active malignancy or infection, unstable psychological profile and with severe obesity (greater than 50% ideal body weight) were not candidates for the surgery. Previous amputation, blindness, previous myocardial infarction, angioplasty or coronary bypass were not contraindications for transplant. Patients were selected based on ABO blood-type compatibility, degree of sensitization, time on the waiting list, a negative T- lymphocytotoxic cross-match, medical urgency, and HLA matching; organ acceptance was limited to ideal donors and a minimum 2-antigen match. Each pancreas was obtained from a heart-beating cadaver donor, with all organ donors weighing at least 66 lbs (mean 149 lbs) and ranging from 10-48 years old. After preparation of the pancreas, the surgeons used a midline intraperitoneal approach with the pancreas transplanted preferentially to the right iliac vessels with end-to-side anastomoses, followed by bladder drainage by a duodenal segment technique. Patients were treated prior to transplant with bowel decontamination (Go-lytely) and antibiotics. They also receieved intraoperative and 3 postoperative doses of intravenous Cefazolin, and postoperative intravenous vancomycin. They also received daily doses of antifungals (ketoconazole or fluconazole). They also received trimethoprim/sulfamethoxazole prophylaxis against pneumocystis) twice weekly for 12 months and intravenous ganci- clovir for 2 wks, followed by oral acyclovir for 3 months. They also received oral aspirin and 5,000 units of heparin intra- operatively, with subcutaneous heparin postoperatively for 5-7 days until ambulatory. All the patients receiving pancreas transplants alone and the first 6 pancreas after kidney transplant patients were treated with quadruple immunosuppression and the remaining 14 pancreas after kidney transplant patients had triple immunosuppression. After a mean period of 28 months (range 1-60), they report patient survival rates of 86% and pancreas allograft survival rates of 52%. 8 patients died, at a mean of 11 months after transplant (all but 1 died in the first year), with 3 cardiac arrests, 2 pulmonary embolisms, and 3 sepsis; the researchers report that "6 deaths were directly attributable to transplant- related complications." The mean length of hospital stay was 18 days and mean hospital charges of $106,341. In the first 3 months after transplant, the "mean number of hospital readmissions was 1.5, and the total inpatient stay averaged 1 month." The authors tell us that, in the first year, the incidence of rejection was 70%, incidence of infection was 55% and incidence of surgical complications was 47%. "One year acturial patient and pancreas allograft survival rates were 89 and 61%, respectively." Citing mean glycohemoglobin levels of 5.1, the authors note, "all patients with functioning pancreas grafts remain completely insulin independent with excellent metabolic control." The authors report that more than 500 solitary pancreas transplants have been done in the US and that, over the last 8 years, overall US 1 yr pancreas graft survival rates have increased from 75-81% after pancreas-kidney transplant, from 51 to 79% after pancreas-after-kidney transplant, and from 44 to 61% after pancreas-transplant-alone. Please see: "Solitary Pancreas Transplantation", by R.J. Stratta MD; L.G. Weide MD PhD; R Sindhi MD; D. Sudan, MD; J.J. Jerius MD; J. Larsen MD; K Cushing RN BSN, M Grune MD and S Radio MD, published in Diabetes Care, v 20 n 3, March 1997, p. 362-367.