**1. Introduction**

Pancreas Transplantation aims at providing Beta cells replacement in diabetic patients, especially for type 1 diabetes recipients in whom Beta cells had been destroyed by an autoim‐ mune process. The final achievement is to restore a normal physiological control of glucose metabolism in order to halt or reverse the secondary complications of diabetes i.e. retinopathy, neuropathy, nephropathy, micro – and macro - angiopathy [1]. That can be achieved by a vascularised pancreas graft (referred as Pancreas Transplantation, PT) or by islet grafting (referred as Islet Transplantation, IT). The former PT includes transplanting 95% of unuseful cells, the exocrine part from one pancreas, while the last one IP, embolizing into the recipient liver, Islets of Langerhans after digestion and purification of several human pancreases. Three types of PT can be performed: the pancreas and a kidney are simultaneously transplanted with a single induction of immunosuppression (IS) therapy in hoping to correct both uremia and diabetes mellitus (SPK = Simultaneous Pancreas and Kidney Transplantation); the pancreas is transplanted after a successful kidney graft allowing two induction therapies along with the basic IS treatment (PAK = Pancreas After Kidney Transplantation) ; and finally the Pancreas can be transplanted alone in pre-uremic recipients with unawareness hypoglycaemic events or with rapidly evolving secondary complications of diabetes such as proliferative retinopathy, or advanced neuropathy (PTA = Pancreas Transplantation Alone) [1].

Moreover, in SPK, both organs the Pancreas and the Kidney are procured from the same deceased donor, either donor after brain death (DBD) or donor after cardiac death (DCD). In some US institutions, a segmental pancreas and the left kidney, are procured in a living donor [2], using a laparoscopic approach in the more recent year [3]. For PAK, in order to avoid an excessive IS load and two induction therapies, other institutions had proposed whenever possible to keep in stand-by the potential live kidney donor until a cadaver whole pancreatic

© 2013 Squifflet; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

compatible graft is available [1]. By contrast, the number of PTA remains limited in non uremic recipients with life-threatening complications of diabetes, in whom one might hope to avoid the hypoglycaemic events with a successful graft. That can also be achieved with IT. But except for rare cases, insulin independence with IT requires more than a single human pancreas and is limited over time [1]. Moreover, IT needs costly materials, chambers and rooms for prepa‐ ration. That's why IT will not be included in the present report.

donor's whole pancreas and attached duodenum extraperitoneally to the 32-Year-old recipi‐ ent's left iliac fossa (Fig 2). This transplant achieved a more prolonged state of graft function, but rejection treatment had to be instituted three and eight weeks post-transplant. Both rejection episodes affected the graft duodenum. The recipient was on insulin when she died

Kidney and Pancreas Transplantation: The History of Surgical Techniques and Immunosuppression

http://dx.doi.org/10.5772/55347

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**Figure 2.** Drawing of the first whole pancreas transplant with cutaneous graft duodenostomy (from Lillelei et al.) [5]

After that series of 13 Pancreas Transplants, R. Lillehei concluded that most complications were associated with kidney graft rejection without pancreas rejection and recipient death [5, 6, 7].

After the first four pancreas transplants at the University of Minnesota, the next four trans‐ plants were performed in South America in 1968; [8, 9, 10]; three were performed in Brazil and one in Argentina at the Buenos Aires Hospital. Only one functioned sufficiently to induce

In 1969, two other U.S. institutions performed one SPK transplant each: one at the University of Colorado (Fred Merkel and Thomas Starzl) and one at the University of California, Irvine Medical Center (John Connolly). [8, 11]. The first pancreas transplant in Europe, along with a kidney transplant, was performed in 1972 at Guys Hospital, in London, U.K. (Mick Bewick). [8].

By the 1970s, only 25 pancreas transplants had been performed at six institutions worldwide. Two-thirds of those early pancreas transplants were done along with a simultaneous kidney transplant. Exocrine secretions had been drained by duct ligation, cutaneous duodenostomy, or enteric drainage using a Roux-en-Y loop. Of these 25 grafts, only one, from Lillehei's original

On November 24, 1971, Marvin Gliedman at Montefiore Hospital and Medical Center in New York performed the first pancreas transplant using urinary drainage via the native ureter [12]. Gliedman and associates performed a total of 11 ureteral pancreas transplants in the early 1970s (Fig 3) with one graft functioning for 22 months and another for 50 months – at that point

insulin-independence and was subsequently lost to rejection at 4 months. [10].

series, functioned for almost one year, and none for more than one year.

four months post transplant from sepsis.
