The Clinical Research Progress Of Pancreas Transplantation

Pancreatic transplantation is currently the only radical treatment for insulin-dependent diabetes and has been identified as the standard treatment for end-stage renal disease in type 1 diabetes.Since the first pancreatic transplantation in the world in 1966,there are more than 1,000 surgeries in one year in the current world,the evolution and development of pancreas transplants are dependent on the progression of surgical techniques,protection of transplanted organs,and immunosuppression.SPK is still the most important surgical method in pancreas transplantation,accounting for 70%of the total,with a one-year survival rate of 95%and graft survival rate of 90%.The process of pancreas transplantation includes the harvesting and trimming of transplanted organs and organ transplantation of recipients.Among them,exocrine and endocrine drainage of transplanted pancreas is the most important task in transplant surgery.Although early extra-pancreatic drainage has played an enormous role in the early history of pancreas transplantation,with the advancement of surgical techniques,the optimization of immunosuppressive regimens and the appearance of long-term complications of bladder drainage have been gradually replaced by extra-intestinal drainage.For internal drainage,current research centers are more inclined to systemic venous drainage.However,no matter which method of external drainage and internal drainage,no significant differences in the survival rate of patients and grafts are reported.Therefore,more powerful proofs from multi-center,large-scale randomized controlled clinical trials are still needed.Benefit from diverse immunosuppressive regimens at present,postoperative rejection can be limited to 5-25%.With antibody induction,tacrolimus and MMF,together with short-acting glucocorticoid maintenance therapy,are the most common treatment options.Pancreatic transplants are still the preferred alternative for the treatment of insulin-dependent diabetes until new treatments can achieve long-term insulin independence and better treatment outcomes.Lack of uniform standards and prospective studies of pancreas transplantation for the methods and outcomes are significant obstacles to the continuous development of the surgery.