PANCREAS TRANSPLANTATION IN DOG AND MAN 
F. K. Merkel* 
Experience with the canine experimental model has 
shown that the pancreas can be transplanted and that 
such a graft can correct either surgically or medically 
induced diabetes. Operative techniques have been devel- 
oped and the tolerable ischemic interval has been de- 
fined at one hour. Lessons learned in the laboratory 
have now been transposed to the clinical setting. The 
human pancreas transplantation experience is summa- 
rized. 
INTRODUCTION 
"Though a simple operative curiosity- 
today, the transplantation of a gland may 
, perhaps some day have a practical applica- 
tion." 
Alexis Carrel, 1901 
Animal models often cannot duplicate the 
human or his diseases. However, lessons learned 
from attempts at canine pancreas transplanta- 
tion have been applied to the juvenile diabetic 
and served to encourage the use of the procedure 
in man. 
Since the introduction of parenteral insulin 
for the treatment of juvenile diabetes mellitus 
by Banting and Best, prevention of ketoacidosis 
has been possible.^ Despite careful use of insu- 
lin and diet, hov^^ever, little has been done to 
prevent the progressive, destructive angiopathy 
of this disease. 
Thus, the life span of an individual develop- 
ing overt diabetes as a child is two-thirds that 
of the general population. The average age of 
death of a patient exhibiting diabetes mellitus 
by nine years of age is 35 years. Renal and car- 
diovascular problems cause 45 per cent of the 
deaths due to diabetes. Diabetes is also the third 
leading cause of blindness in the United 
States.2 
This serious inherited metabolic defect afflicts 
* Northwestern University Medical School, Chicago, Illinois. 
more than 562,000 persons each year. Clearly, it 
is vital to find a better solution to this problem. 
Although numerous theories exist concerning 
the etiology of juvenile diabetes mellitus, pan- 
creas allografting offers the only definitive 
means of testing the hypothesis that absence of 
a precise, moment-to-moment control of glucose 
metabolism results in the angiopathy. This an- 
giopathy can be diffuse, affecting multiple 
organ systems, or may principally affect only 
one organ. 
CANINE PANCREATIC TRANSPLANTATION 
Pancreatic allografts were first successfully 
carried out in dogs by Gayet and Houssay 
using cannulas to effect the vascular anas- 
tomoses.^-* Clotting caused failure after 
several hours. A vascular suture technique was 
first used by Lichtenstein in 1957; however, 
venous thromboses resulted in a high incidence 
of failure.^ Since that date, a variety of tech- 
niques were reported for whole organ trans- 
plants of the pancreas for its endocrine func- 
tion. Essentially, such grafts consisted of either 
a segment of the pancreas, the pancreatico-duo- 
denal complex, or the pancreas alone. ''■^^ 
These studies demonstrated the technical feasi- 
bility of pancreas transplantation in the dog. 
Vascular complications were common in most of 
these preparations, however, causing failure of 
one-third to one-half of the grafts. 
If the operation was to be tried in humans, it 
was essential to develop a more successful vas- 
cular technique for pancreas grafting. It ap- 
peared likely that the cause of these thromboses 
was the small blood supply the pancreas re- 
ceived in the dog ; whereas a renal allograft re- 
ceives one-quarter of the cardiac output, the 
pancreas only receives one to two per cent of 
the cardiac output. A technique was developed 
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