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Fig. 7.1. Annual number of pancreas transplants performed in the U.S. according to category (from the International Pancreas Transplant Registry).

The third category for pancreas transplantation is in non-uremic, non-kidney transplant patients with type 1 diabetes. In this situation one assesses the risk of immunosuppression to be less than the current clinical condition with conventional exogenous insulin administration. These patients with diabetes have extremely labile disease, such that there is difficulty with day-to-day living, associated with frequent emergency room visits and inpatient hospitalizations for hypoglycemia or diabetic ketoacidosis. Other patients may have significant difficulty with hypoglycemic unawareness that results in unconsciousness without the warning. This can be a devastating condition for these select patients that affects their employment, their ability to have a license to drive, and concern about suffering lethal hypoglycemia while asleep. The indications for a pancreas transplant alone are essentially identical to those patients being considered for an islet transplant. However, in the former situation, there are fewer contraindications with respect to body mass index and insulin requirements.

An extremely interesting patient population for which the benefits of pancreas transplantation are being more thoroughly explored are those with early diabetic nephropathy. These patients show the presence of micro-albuminuria indicating the renal diseases at a stage where progression is inevitable without amelioration of the diabetic state. It is clear that either dialysis or kidney transplantation will ultimately be required. It has been established that pancreas transplant performed at this early stage of diabetic nephropathy is capable of halting and reversing the diabetic process affecting the native kidneys. It is possible that added beneficial

Fig. 7.2. The number of patients in the U.S. waiting for an SPK transplant, receiving an SPK transplant and the number of cadaver organ donors per year.

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