In the era of diabetes epidemiology, long-term diabetes complications still remain a challenge. The risks of vision loss, extremity amputation and hemodialysis are motivating to apply for pancreas transplantation. The main goal is achieving normoglycemia but it is not always receivable. Delayed graft function is a well recognized phenomenon in kidney transplantation, but there are only a few reports of graft malfunction after pancreas transplantation.
The aim of the study was to evaluate pancreas graft function after simultaneous pancreas and kidney transplantation (SPK).
Since 2001 till October 2017 we performed 193 pancreas transplantations at the Department of Gastroenterological Surgery and Transplantation at the Central Clinical Hospital of the Ministry of the Interior in Warsaw.  There were 159 cases of simultaneous pancreas and kidney- SPK, 25 pancreas alone PTA, 5 pancreas after kidney PAK and 4 retransplantations after SPK. The 5-years survival of the patients in our cohort is 84%, for the pancreas grafts 65% and for kidney graft 83%. In 10 patients we observed delayed pancreas graft function in the early period after transplantation. 2 patients required pancreas graft biopsy, but there was no evidence of graft rejection in specimens. After 3 months, 8 patients obtained a good graft function and were insulin independent. 2 patients necessitate oral hypoglycemic drugs. There was no correlation between delayed pancreas graft function and kidney graft function observed. All patients during the observation had positive c-peptide and no abnormalities in US.
If the pancreas graft does not initiate to function for 3 months after transplantation, patients are not willing to be insulin independent. Insulin requirement in the early post-transplantation period does not determine lack of function of the graft but its delayed function. While expecting graft function to develop, the patients should be administrated psychological support, medical assistance and physical rehabilitation.