A simplified multivisceral transplantation procedure for patients with combined end‐stage liver disease and type 2 diabetes mellitus

Abstract

In liver transplant patients with type 2 diabetes mellitus (DM), the disease worsens after transplantation because of longterm use of diabetogenic immunosuppressive drugs, making management of those patients a great challenge. The objective of our study was to evaluate the safety and efficacy of a simplified multivisceral transplantation (SMT) procedure for the treatment of patients with end-stage liver disease and concurrent type 2 DM. Forty-four patients who had pretransplant type 2 DM were included. A total of 23 patients received SMT, and 21 patients received orthotopic liver transplantation (OLT). Patient and graft survivals, complications, diabetic control, and quality of life (QOL) were retrospectively analyzed in both groups. The 1-, 3-, and 5-year cumulative patient and graft survival rates were 91.5%, 75.4%, and 75.4% in the SMT group and were 94.4%, 64.4%, and 64.4% in the OLT group, respectively (P = 0.70). Interestingly, 95.7% (22/23) of patients achieved complete remission from DM after SMT compared with 16.7% (3/18) of patients after OLT. The occurrence of biliary complication was significantly higher in the OLT group than that in the SMT group (23.8% versus 0.0%; P = 0.01). Moreover, better QOL was observed in the SMT group than that in the OLT group. In conclusion, the SMT procedure we described here is a safe and viable option for patients with end-stage live disease and concurrent type 2 DM. This SMT procedure offers excellent transplant outcomes and QOL. Liver Transplantation 23 1161-1170 2017 AASLD.

A Multidisciplinary Approach to Pretransplant and Posttransplant Management of Cystic Fibrosis–Associated Liver Disease

“…Reprinted with permission from Liver Transplantation . Copyright 2017, American Association for the Study of Liver Diseases …”

“…Technical considerations in LP transplantation have centered on vascular reconstruction for both the arterial and venous systems. Technical refinements have been made to simplify LP transplantation including (49) the utilization of a Y arterial graft between the donor celiac and superior mesenteric artery to eliminate the need for an infrarenal aortic graft ( Fig. 2) and utilization of a duodenoduodenostomy to simplify the biliary reconstruction.…”

“…2) and utilization of a duodenoduodenostomy to simplify the biliary reconstruction. (49) LP transplantation represents an appealing option for patients with CF as the vast majority have both exocrine and endocrine insufficiency. However, in the United States, its utility is limited by the relative low number of LP transplants performed and the volume required to maintain accreditation.…”

Outcomes of Combined Liver and Pancreas Transplantation: A Review of the SRTR National Database and a Report of the Largest Single Center Series

“…Our previous report (11) described in detail the surgical procedure of SMT in the FAH group. The procedure of organ donation and procurement strictly followed the Chinese guideline of organ donation (12).…”

“…LPTx has been proven to be a possible treatment for patients with ESLD and concurrent type 1 diabetes mellitus (T1DM) (9, 10), while its use in ESLD and concurrent insulindependent type 2 diabetes mellitus (T2DM) remains a matter of debate. We reported a modified LPTx procedure, called simplified multivisceral transplantation (SMT), for the treatment of patients with ESLD and concurrent T2DM (11).…”