While either pancreas or pancreatic islet transplantation can restore endogenous insulin secretion in patients with diabetes, no beta-cell replacement strategies are recommended in the literature. For this reason, the aim of this national expert panel statement is to provide information on the different kinds of beta-cell replacement, their benefit-risk ratios and indications for each type of transplantation, according to type of diabetes, its control and association with end-stage renal disease. Allotransplantation requires immunosuppression, a risk that should be weighed against the risks of poor glycaemic control, diabetic lability and severe hypoglycaemia, especially in cases of unawareness. Pancreas transplantation is associated with improvement in diabetic micro- and macro-angiopathy, but has the associated morbidity of major surgery. Islet transplantation is a minimally invasive radiological or mini-surgical procedure involving infusion of purified islets via the hepatic portal vein, but needs to be repeated two or three times to achieve insulin independence and long-term functionality. Simultaneous pancreas-kidney and pancreas after kidney transplantations should be proposed for kidney recipients with type 1 diabetes with no surgical, especially cardiovascular, contraindications. In cases of high surgical risk, islet after or simultaneously with kidney transplantation may be proposed. Pancreas, or more often islet, transplantation alone is appropriate for non-uraemic patients with labile diabetes. Various factors influencing the therapeutic strategy are also detailed in this report.
La adolescencia marca pautas para construir una personalidad y tener un lugar en el mundo en el cual se pueda encajar, por lo que la comunicación social y las relaciones sociales, serán importantes para cumplir este objetivo en esta etapa, siendo las redes sociales el puente o camino para trabajarlas efectivamente. Sin embargo, las redes sociales abren una cantidad de información que los estudiantes pueden tomar o ignorar, pero es importante el poder tener en cuenta que el trabajo que puedan hacer los estudiantes al respecto, tendrá una ventaja en la construcción del mismo, dado que están expuestos a estas de manera diaria. Si se aplica una serie de actividades a elegir por parte del estudiante, para que utilicen las redes sociales y las adapten a las características de la clase, permitirá que exista un interés más auténtico en el estudiante al tenerlo inmerso en las actividades y sienta una pertenencia en la construcción de su aprendizaje.
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