as result of improved surgical techniques and newer immunosuppressive regimens contributing significantly to better graft survival , exocrine pancreas transplantation remains the standard treatment of choice for patients with diabetes mellitus complicated by end - stage renal disease .
histological assessment continues to play an important role in the diagnosis of graft complications after pancreas transplantation , especially for evaluating allograft rejection where histopathology is still considered the gold standard .
a review elaborates on the current types of pancreas transplants and focuses on the patterns of allograft injury that are encountered in posttransplantation pancreas biopsies along with the pertinent differential diagnoses .
in addition to optimal histological assessment , as in any other organ transplant setting , clinical information including indication and duration of transplant as well as other serologic work - up must be taken into consideration during clinical decision making for optimal graft outcome .
several lines of laboratory and clinical evidence suggest that in a carefully selected group of patients , long - term glycemic control and allograft function are similar to that observed for pancreas transplants performed for type 1 diabetes .
the first successful pancreas transplantation in conjunction with a simultaneous kidney transplantation ( spkt ) was performed by kelly and lillehei from the university of minnesota in 1966 .
one of the alternative options to spkt for type i diabetics with renal failure is sequential transplant of a living donor kidney followed by a deceased donor pancreas transplant ( pancreas after living donor kidney transplant , palk ) .
adults ( age 18 - 59 years ) with type i diabetes who were waitlisted for kidney - pancreas and received a spkt or palk between 2000 and 2007 were now studied .
of 11,966 patients who received a kidney transplant , 807 received a palk and 5580 received a spkt .
median time to pancreas from kidney transplant was 336 ( 25 - 75 % : 185 - 602 days ) days .
average hospital stay for spkt recipients was 13  15 days , whereas for palk recipients was 6  4 days and 10  8 days for kidney and pancreas transplants , respectively .
after controlling for confounding factors , patients receiving palk had better patient survival ( hr 0.52 ; 95 % confidence interval 0.39 to 0.70 ) and kidney survival ( hr 0.48 ; 95 % confidence interval 0.39 to 0.60 ) but worse pancreas survival ( hr 1.37 ; 95 % confidence interval 1.16 to 1.62 ) compared with spkt .
thus , among those who were waitlisted for a kidney - pancreas transplant , 53 percent received a kidney - pancreas transplant . of those who received a kidney - pancreas transplant , 87 percent patients underwent spkt and 13 percent underwent palk .
it was found an inferior pancreas graft survival and longer total transplant hospitalization in palk .
pancreas transplantation provides the best glycemic control option for diabetes mellitus but is associated with significant morbidities related to infectious disease .
it was performed a retrospective study of a cohort of consecutive pancreas transplantation recipients in whom pancreas transplantation was performed from 1998 to 2006 ( n=216 ) and followed up them until 2008 .
data regarding infections , rejection , infection chemoprophylaxis , graft failure , absolute lymphocyte counts , and mortalities were collected .
simultaneous pancreas and kidney , pancreas transplantation alone , and pancreas after kidney ( pak ) transplantations were performed in 42 , 67 , and 107 patients , with a mean age at transplantation of 47 , 41 , and 44 years . of the simultaneous pancreas and kidney , pancreas transplantation alone , and
pak transplant recipients , 55 percent , 37 percent , and 59 percent were men .
overall , 63 percent developed a serious infection during the median follow - up of 6.4 years .
mean ( range ) number of infectious episodes was 2.3 ( 1 - 12 ) , with mostly bacterial infections both within ( 68 % ) and after 1 year ( 78 % ) .
incidence of bacterial and viral infections was greatest in the first 3 months after transplantation .
bladder exocrine drainage was significantly associated with higher risk of infection ( hazard ratio 2.5 ) .
infection within the first 3 months after transplantation was related to higher mortality after the first 3 months ( hazard ratio 3.19 ) .
absolute lymphocyte counts was significantly associated with the risk of first infections and bacterial infections .
therefore , the incidence of infections after pancreatic transplantation was 63 percent and mostly bacterial .
 a pancreas transplant is a surgical procedure to place a healthy pancreas from a donor into a patient whose pancreas no longer functions properly . 
 exocrine pancreas transplantation remains the standard treatment of choice for patients with diabetes mellitus complicated by end - stage renal disease . 
 the use of pancreas transplantation for type 2 diabetes mellitus is an emerging concept . 
 a pancreas transplant is often done in conjunction with a kidney transplant . 
 even if pancreas transplantation provides the best glycemic control option for diabetes mellitus , it is associated with significant morbidities related to infectious disease . 
 the present article provides with a review of pancreatic transplantation . 
Introduction
In diabetes type 2
Pancreas after living donor kidney transplant
Infections after transplantation