The collective advances made by many groups have significantly improved the results of
pancreas transplantation. We have focused on the development of safe and effective
immunotherapy, including a new protocol of rapid withdrawal of
corticosteroids, the analysis of surgical technique of pancreas exocrine drainage on outcome and the role of SPK
transplantation in patients with significant
cardiovascular disease. We have found that multimodal
immunotherapy including induction with
tacrolimus-based maintenance combined with either MMF or
sirolimus, with or without
corticosteroids, resulted in excellent patient and graft survival rates with low rates of rejection. In this setting, enteric drainage was preferable to bladder drainage because of a lower rate of complications leading to
hospital readmissions. Careful pretransplant screening for
cardiovascular disease should be routinely performed for all SPK candidates. If successful coronary revascularization can be achieved, these patients can safely undergo SPK
transplantation, with 5-year outcomes similar to those for recipients without
coronary disease. Finally, we have observed that
pancreas transplantation has an important ameliorating effect on
hypertension that is independent of the method of pancreas exocrine drainage.