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Segmental pancreatic transplantation in Stockholm.

Fifty-nine pancreatic transplantations have been performed at Huddinge Hospital between May 1974 and October 1985 with a substantial improvement in results over the years. In the most recent series, consisting of 19 combined renal and pancreatic transplantations performed May 1984 to September 1985; the 1-year actuarial patient survival and pancreatic graft survival were 86% and 66% respectively. Thirteen of these grafts are functional presently, at 18 to 2 months, and all such patients are insulin free and exhibit normal metabolic control. Our practice includes drainage of the pancreatic juice to the exterior by means of a pancreatic duct catheter during the first 2-3 postoperative weeks, thereby promoting healing of the pancreatico-enteric anastomosis. Although cold ischemia time was kept low in this series, a moderate graft pancreatitis developed, with a peak serum amylase level of 16.8 + 2.2 ukat/l and a peak amylase activity in the peripancreatic fluid of 280 + 110 ukat/l. The volume of pancreatic juice from the ductal catheter was very low in the first postoperative days but then rose to reach a plateau level of about 500 ml/day. The amylase activity in this juice was very high (9100 + 2500 ukat/l) during the first postoperative day, but then gradually decreased to reach a steady level around 3000 ukat/l after 4-7 days.