Book Review

Transplantation of the Pancreas

N Engl J Med 2005; 353:1534-1535October 6, 2005

Article

Transplantation of the Pancreas
Edited by Rainer W.G. Gruessner and David E.R. Sutherland. 676 pp., illustrated. New York, Springer-Verlag, 2004. $399. ISBN: 0-387-00589-7

Rigorous control of hyperglycemia has been shown to slow the progression of complications in patients with diabetes or prevent them altogether. Nonetheless, the management of blood glucose by the administration of insulin has failed to achieve true euglycemia, despite the intensive efforts of patients with diabetes and their caregivers. Even insulin therapy with the use of a pump or multiple daily injections fails to maintain normal values of glycosylated hemoglobin. For this reason, pancreas transplantation has been developed as a way of ensuring long-term normal glucose homeostasis in type 1 diabetes mellitus.

(Figure)Oskar Minkowski (1858-1931).

The first successful human pancreatic transplants were performed at the University of Minnesota in 1966. In one of the first two recipients, normoglycemia developed rapidly and continued for months. Over the next 16 years, however, rates of 1-year survival of the graft remained below 20 percent. Improved graft survival followed on new developments in immunosuppressive therapy and surgical techniques, and the survival rate of pancreas grafts now equals that of kidney transplants. Today, combined pancreatic–renal transplantation is considered the standard of care for selected patients with type 1 diabetes who require kidney transplantation.

Transplantation of the Pancreas, edited and almost exclusively written by authors currently working at or trained at the University of Minnesota, is meant to be a complete reference textbook in the field of pancreatic transplantation. Its excellent chapters consist of discussions of historical considerations, the pathogenesis of diabetes, and the immunology and treatment of rejection. The multiple surgical possibilities for use in both the donor and the recipient are carefully addressed, with excellent color illustrations of operative techniques.

Evaluation of the recipient, postoperative management of the “routine” patient, and the multidisciplinary diagnosis and treatment of complications are dealt with at great length. The chapters on these subjects, although they present reasonable protocols, suffer from what may be called Minnesota-centricity, because they frequently offer only one view, without an evidence-based explanation. Thus, experienced physicians and surgeons in the field of pancreas transplantation may have disagreements with these sections of the book.

The effect of pancreas transplantation on endocrine function, metabolism, and the secondary complications of diabetes is well handled by authors who have made seminal contributions to this field. A chapter on grafts from living donors — a procedure performed almost exclusively at the University of Minnesota — could have been written only by these authors. Living-donor evaluation and the surgical procedure, including laparoscopy, are well covered. Surgical complications and metabolic outcomes among donors are discussed, though one wishes there were more data available on donor beta-cell function. A final chapter on islet transplantation is an excellent introduction to the topic. In most of the chapters, the references are exhaustive (nearly 450 in the chapter on islet transplantation alone) and wide-ranging.

This textbook will make possible one-stop shopping for surgical and medical transplantation fellows entering the field of pancreas transplantation. It will also serve as a reference for specialists already active in the area, as well as for physicians who may occasionally care for patients living with or considering a pancreas transplant.

Michael E. Shapiro, M.D.
Hackensack University Medical Center, Hackensack, NJ 07601
mshapiro@humed.com