Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy

Kelly, William B.; Lillehei, Richard C.; Merkel, Frank; Idezuki, Yasuo; Goetz, Frederick C.

doi:10.1097/00007890-196801000-00034

Cited by 287 publications

(305 citation statements)

References 0 publications

Supporting

Mentioning

267

Contrasting

Unclassified

Order By: Relevance

“…Simultaneous transplantation of two organs for combined end-stage organ failure has been a reality since 1967 when Kelly et al (1) described the first simultaneous pancreas and kidney transplant for diabetic nephropathy. Later, in 1978, Norman et al (2) described the first combined simultaneous heart and kidney transplant in a patient maintained on an left ventricular assist device (LVAD) for 5 d prior to transplant.…”

Section: Introductionmentioning

confidence: 99%

Simultaneous Heart and Kidney Transplantation in Patients with End-stage Heart and Renal Failure

Leeser

Jeevanandam

Furukawa

et al. 2001

American Journal of Transplantation

View full text Add to dashboard Cite

Combined simultaneous organ transplantation has become more common as selection criteria for transplantation have broadened. Broadening selection criteria is secondary to improved immunosuppression and surgical techniques. The kidney is the most common extrathoracic organ to be simultaneously transplanted with the heart. A series of 13 patients suffering from both end-stage heart and renal failure underwent 14 simultaneous heart and kidney transplantations at Temple University Hospital between 1990 and 1999. This is the largest series reported from a single center. Three patients died during the initial hospitalization for an inhospital mortality of 21%. Of 10 patients who left the hospital, 1-year survival was 100% and 2-year survival 75%. One patient required retransplant for rejection within the first year. Overall mortality at 1 and 2 years was 25 and 41%, respectively. Four out of nine (44%) patients greater than 5 years post-transplant were alive. Of the 10 patients who left the hospital, 66% were alive at 5 years. One patient succumbed to primary nonfunction of the cardiac allograft, while the four other deaths were secondary to bacterial or fungal sepsis. The patient's racial backgrounds were equally divided between African-American and white. These results are similar to those reported in a United Network of Organ Sharing Database (UNOS) registry analysis of 84 simultaneous heart and kidney transplants that found 1-and 2-year survival to be 76 and 67%, respectively. Simultaneous heart and kidney transplantation continues to be a viable option for patients suffering from failure of these two organ systems, although the results do not match those of heart transplant alone.

show abstract

Section: Introductionmentioning

confidence: 99%

Simultaneous Heart and Kidney Transplantation in Patients with End-stage Heart and Renal Failure

Leeser

Jeevanandam

Furukawa

et al. 2001

American Journal of Transplantation

View full text Add to dashboard Cite

show abstract

“…Pancreatico-duodenal transplantation has already been therapeutically used for the treatment of "severe human diabetes mellitus and its complications" [10,11]. The patients required no insulin treatment for 31 to 134 days postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Glucose turnover and insulin secretion in dogs with pancreatic allografts

1970

View full text Add to dashboard Cite

Summary. The endocrine function of pancreaticoduodenal allografts was studied in six dogs and compared with that of normal animals. The grafts were able %o prevent the diabetic ketosis that was observed in a control group after total pancreatectomy without following transplantation. --Systemic hyperglycaemia enhanced the insulin release from the transplanted pancreas, as measured by increased IRI levels after intravenous glucose administration. In contrast, the stimulation of insulin secretion by oral glucose loading was less than in norreal dogs, while the glucose assimilation was also increased in transplanted animals. --It was speculated that the duodenum might be more susceptible to immunological damage than the pancreas, and that consequently an impairment of the resorption of glucose and of the production of intestinal factors controlling the secretion of insulin may result. --In the near future, pancreatico-duodenal transplantation does not appears to become a therapeutical alternative to the conventional treatment of diabetes mellitus in man. IntroductionThe endocrine function of the transplanted pancreas has been repeatedly studied since 1892 when Minkowski used the technique of pedicle transplantation of a pancreatic lobe, by which he demonstrated the relationship between the pancreas and diabetes mellitus [2,4,6,9,17,19,20,21]. An orthotopie pancreatieo-dupdenal transplantation permitting a normal exocrine as well as endocrine function of the graft was used for ~he first time by Largiad~r et al. [12,13, 14]. The transplantation en bloc of the functionally-connected pancreatico-duodenal complex is a technique that may eventually advance to a therapeutical procedure in the surgical treatment of chronic pancreatitis, carcinoma of the pancreas and maybe also diabetes mellitus. In view of this last possibility we were prompted to study the endocrine function of these grafts. Since the dogs survived the operation for approximately three weeks, the experiments were not carried out in the immediate postoperative period when the animals did not yet feed normally and when carbohydrate metabolism was still disturbed.The response of the graft to systemic hyperglycaemia was tested by intravenous glucose administration, and the function of the glucose-responsive "enteroinsular axis" [18] was investigated by oral glucose tolerance tests. Some of the results have previously been published in preliminary form [7].

show abstract

“…Пациентка оставалась инсулиннезависимой в течение 6 дней после транс-плантации. В течение года Lillehei выполнил еще 13 трансплантаций и опубликовал первые резуль-таты, где обсуждались аспекты дренирования экзо-кринного секрета поджелудочной железы и веноз-ной реконструкции, актуальные и по сей день [18].…”

Section: история развития трансплантации поджелудочной железыunclassified

Pancreas transplantation in the treatment of diabetes mellitus type 1: modern aspects

Готье

Арзуманов

2017

RJTAO

View full text Add to dashboard Cite

1 ФГБУ «Национальный медицинский исследовательский центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России, Москва, Российская Федерация 2 НИИ урологии и интервенционной радиологии имени Н.А. Лопаткина -филиал ФГБУ «Национальный медицинский исследовательский радиологический центр» Минздрава России, Москва, Российская Федерация Сахарный диабет является социально значимым заболеванием. В Российской Федерации распространен-ность сахарного диабета 1-го типа составляет 340 тысяч человек, причем около 21% пациентов имеют явления диабетической нефропатии, а также других вторичных осложнений, приводящих к инвалиди-зации и высокой смертности. Существует несколько вариантов заместительной терапии для больных диабетом с терминальной почечной недостаточностью: инсулинотерапия в сочетании с диализом или трансплантацией почки, комбинированная трансплантация почки и поджелудочной железы или ее ос-тровковых клеток. Только трансплантация целой поджелудочной железы в сочетании с трансплантаци-ей почки может обеспечить лучшие отдаленные результаты за счет максимальной нормализации мета-болизма в сравнении с другими видами заместительной терапии. Существенной составляющей успеха трансплантации является тщательная селекция реципиентов с особым вниманием к состоянию сердечно-сосудистой системы. Крайне важной задачей считается проведение оценки пригодности трансплантата поджелудочной железы. Необходимо учитывать большой спектр донорских показателей, использование интегральных индексов может несколько упростить и систематизировать процесс оценки. Не менее зна-чимым для результатов считается проведение адекватной противоишемической защиты панкреатодуо-денального комплекса. Несмотря на постоянный прогресс в развитии различных методик консервации, холодовая перфузия с использованием раствора Университета Висконсин (UW) остается «золотым стан-дартом». Эволюция хирургической техники трансплантации привела к наиболее физиологичным вари-антам дренирования экзокринного секрета и венозного оттока поджелудочной железы, которые призваны улучшить отдаленные метаболические эффекты и снизить частоту осложнений.Ключевые слова : трансплантация, почка, поджелудочная железа, иммуносупрессия, консервация, ишемия реперфузия, хирургическая техника.

show abstract

Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy

Cited by 287 publications

References 0 publications

Simultaneous Heart and Kidney Transplantation in Patients with End-stage Heart and Renal Failure

Simultaneous Heart and Kidney Transplantation in Patients with End-stage Heart and Renal Failure

Glucose turnover and insulin secretion in dogs with pancreatic allografts

Pancreas transplantation in the treatment of diabetes mellitus type 1: modern aspects

Contact Info

Product

Resources

About