[Pancreas transplantation].
Margarida BastosMaria Vítor CamposCarla BaptistaRui AlvesCarlos A. C. BastosAlfredo MotaManuela CarvalheiroLinhares FurtadoAlmeida Ruas
0
Citation
0
Reference
10
Related Paper
Abstract:
A clinic case of simultaneous pancreas/kidney transplantation on a type 1 diabetic patient is described. A six years follow-up was made with both organs functionating and a good quality of live. Then the authors make a review of the available surgical techniques, indications and complications of this form of treatment. A comparison between the Portuguese and the International experience was discussed.Keywords:
Pancreas transplantation
Cite
Islet and pancreas transplantation may compete for a limited number of organs. We analyzed records from the national Swiss transplant registry during a 4-year period to investigate the proportion of donors that are suitable for islet and pancreas transplantation. Suitability for pancreas transplantation was mainly defined as: age 10-45 years; weight
Pancreas transplantation
Islet cell transplantation
Cite
Citations (29)
Vascularized pancreas transplantation (PT) is becoming an accepted therapy for selected type I diabetic patients. However, selection and evaluation criteria remain uncertain. In the last 3.5 years, we have interviewed 205 and evaluated 151 diabetic patients for PT. The degree of renal dysfunction (creatinine clearance below 45 ml/min) was used to select patients for combined pancreas-kidney transplantation (PKT) or solitary pancreas transplantation (PTA) (clearance above 70 ml/min). The cardiovascular evaluation (stress thallium study with liberal use of coronary angiography) was used to determine operative risk and provided the other major selection criterion. A total of 104 patients were selected as candidates for PT; 70 have undergone PKT with 98.6% patient survival (1 cardiovascular death), 97.1% kidney graft survival, and 94.2% pancreas graft survival. Thirty-three evaluated patients (24.1%) were not accepted as candidates for PT; 13 have undergone cadaveric kidney transplantation, 5 were placed on the kidney waiting list, and 9 have died. Criteria for PTA include 2 or more diabetic complications or hyperlabile diabetes. Patient (n=12) and pancreas graft survival after PTA is 83.3 and 50%, respectively. Our conclusion is that a multidisciplinary
Pancreas transplantation
Cadaveric spasm
Cite
Citations (34)
The first attempt to cure type 1 diabetes by pancreas transplantation was done at the University of Minnesota, in Minneapolis, on December 17, 1966, followed by a series of whole pancreas transplantation. Due to the lack of potent immunosuppressive drugs, rejections and infections, it was concluded that pancreas was less antigenic than the kidney which was less antigenic than the duodenum. It opened the door to a period, between the mid 70's to mid 80's where only segmental pancreatic grafts were used in the recipient. Numerous techniques for diverting or dealing with the pancreas juice secretion were described, none of them being satisfactory. In the late 70ȉs - early 80's, three major events happened and boosted the development of pancreas transplantation: firstly the introduction of Cyclosporine A in the clinical field, secondly the organization on March 1980, of the first international meeting on Pancreas Transplantation with the first report of the International Pancreas Transplantation Registry (IPTR) and finally in 1982, the organization of the first informal so-called Spitzingsee meetings where pancreas transplantation successes but mainly failures were discussed which precluded the onset of IPITA (International Pancreas and Islet Transplantation Association), EuroSPK (European Study Group for simultaneous Pancreas and Kidney Transplantation) and EPITA (European Pancreas and Islet Transplantation Association).During one of the Spitzingsee meetings, participants had the idea to renew the urinary drainage technique of the exocrine secretion of the pancreatic graft with segmental graft and eventually with whole pancreaticoduodenal transplant. That was clinically achieved during the mid 80's and remained the mainstay technique during the next decade. In parallel, the Swedish group developed the whole pancreas transplantation technique with enteric diversion. It was the onset of the whole pancreas reign. The enthusiasm for the technique was rather moderated in its early phase due to the rapid development of liver transplantation and the need for sharing vascular structures between both organs, liver and pancreas. During the modern era of immunosuppression, the whole pancreas transplantation technique with enteric diversion became the gold standard for simultaneous pancreas and kidney transplantation (SPK), with portal drainage of the venous effluent of the pancreas, even for pancreas after kidney (PAK) or pancreas transplantation alone (PTA). Today, there remains room for improvement: safety of using the duodeno-duodenal anastomosis technique must be confirmed by prospective analysis while preventing ischemic reperfusion injuries, using specific drugs; that must be assessed in new trials.
Pancreas transplantation
Exocrine secretion
Cite
Citations (63)
Pancreas transplantation
Cite
Citations (2)
In the field of pancreas transplantation great progress has been made in recent years. While the transplantation of the whole organ has lost importance, success could be reached with the transplantation of isolated islets of Langerhans and with the segmental pancreas transplantation in experiments and in clinical practice. The present-day research is focused particularly on influencing the antigenicity of the endocrine pancreas tissue and on methodical problems of segmental pancreas transplantation.
Pancreas transplantation
Cite
Citations (0)
Abstract Since the first pancreas transplants in the early 1960s, whole‐organ pancreas transplantation, either alone or combined with kidney transplantation, has become commonplace in many countries around the world. Whole‐organ pancreas transplantation is available in the UK, with ~200 transplants currently carried out per year. Patient survival and pancreas graft outcome rates are now similar to other solid organ transplant programmes, with high rates of long‐term insulin independence. In the present review, we will discuss whole‐pancreas transplantation as a treatment for diabetes, focusing on indications for transplantation, the nature of the procedure performed, graft survival rates and the consequences of pancreas transplantation on metabolic variables and the progression of diabetes‐related complications.
Pancreas transplantation
Cite
Citations (38)
Pancreas transplantation
Cite
Citations (0)
Pancreas transplantation
Cite
Citations (11)
Pancreas transplantation is the only therapeutic measure currently available to achieve long term normoglycemia and normal HbA1 levels in diabetic patients. A live long immunosuppression with it's side effects is the price payed for that treatment. Like in renal transplantation an alternative treatment is available for potential pancreas transplant recipients so that most transplant centers are willing to perform pancreas transplantation as a combined kidney pancreas transplantation in patients with diabetic nephropathy only. This article reviews indications, technique, results and complications of simultaneous kidney pancreas transplantation and pancreas after kidney transplantation.
Pancreas transplantation
Immunosuppression
Cite
Citations (1)