Chronic rejection: the next major challenge for pancreas transplant recipients

Humar, Abhinav; Khwaja, Khalid; Thiagarajan, Ramcharan; Asolati, Michele; Kandaswamy, Raja; Gruessner, Rainer W.G.; Sutherland, David E.R.; Gruessner, Angelika C.

doi:10.1097/01.tp.0000079457.43199.76

Cited by 76 publications

(51 citation statements)

References 17 publications

(15 reference statements)

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“…They observed that minimal-grade rejection in SPT rarely progressed to more severe grades of rejection, and was not associated with inferior graft survival over a period of 2 years when untreated. Although long-term outcomes are unknown with this approach, Humar et al have shown that chronic rejection is the second most common cause of pancreas graft loss after technical failure [26]. Multivariate analysis showed that the most significant risk factor for pancreas graft loss due to chronic rejection was a previous episode of acute rejection and SPT.…”

Section: Discussionmentioning

confidence: 99%

Pancreas Transplantation: Lessons Learned From a Decade of Experience at Wake Forest Baptist Medical Center

et al. 2011

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■ AbstractThis article reviews the outcome of pancreas transplantations in diabetic recipients according to risk factors, surgical techniques, and immunosuppression management that evolved over the course of a decade at Wake Forest Baptist Medical Center. A randomized trial of alemtuzumab versus rabbit anti-thymocyte globulin (rATG) induction in simultaneous kidney-pancreas transplantation (SKPT) at our institution demonstrated lower rates of acute rejection and infection in the alemtuzumab group. Consequently, alemtuzumab induction has been used exclusively in all pancreas transplantations since February 2009. Early steroid elimination has been feasible in the majority of patients. Extensive experience with surveillance pancreas biopsies in solitary pancreas transplantation (SPT) is described. Surveillance pancreas biopsy-directed immunosuppression has contributed to equivalent long-term pancreas graft survival rates in SKPT and SPT recipients at our center, in contrast to recent registry reports of persistently higher rates of immunologic pancreas graft loss in SPT. Furthermore, the impact of donor and recipient selection on outcomes is explored. Excellent results have been achieved with older (extended) donors and recipients, in recipients of organs from donation after cardiac death donors managed with extracorporeal support, and in African-American patients. Type 2 diabetics with detectable C-peptide levels have been transplanted successfully with outcomes comparable to those of insulinopenic diabetics. Our experiences are discussed in the light of findings reported in the literature.

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Section: Discussionmentioning

confidence: 99%

Pancreas Transplantation: Lessons Learned From a Decade of Experience at Wake Forest Baptist Medical Center

et al. 2011

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“…First, a pancreas allograft is more immunogenic than a liver allograft (29). Therefore, one cannot exclude that addition of the pancreas to the liver may make the cluster graft more immunogenic.…”

Section: Discussionmentioning

confidence: 99%

Combined ‘En Bloc’ Liver and Pancreas Transplantation in Patients with Liver Disease and Type 1 Diabetes Mellitus

Pirenne¹,

Deloose²,

Coosemans³

et al. 2004

American Journal of Transplantation

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Liver disease alters the glucose metabolism and may cause diabetes, but this condition is potentially reversible with liver transplantation (LTx). Type 1 diabetes mellitus may be coincidentally present in a LTx candidate and immunosuppressive drugs will aggravate diabetes and make its management more difficult for posttransplant. In addition, diabetes negatively influences outcome after LTx. Therefore, the question arises as to why not transplanting the pancreas in addition to the liver in selected patients suffering from both liver disease and Type 1 diabetes. We report two cases of en bloc combined liver and pancreatic transplantation, a technique originally described a decade ago in the treatment of upper abdominal malignancies but rarely used for the treatment of combined liver disease and Type 1 diabetes. Both recipients are currently liver disease-free and insulin-free more than 2 and 4 years posttransplant, respectively. Surgical, medical and immunological aspects of combined liver-pancreas transplantation are discussed in the light of the existing relevant literature.

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“…As principais causas de insucesso do transplante pancreático incluem as perdas técnicas e a rejeição crônica, que ocorrem em cerca de 13% e 8,8% dos casos, respectivamente (37,38). As perdas técnicas incluem trombose (52%), pancreatite (20,3%), infecções (18,7%), fístulas (6,5%) e sangramento (2,4%) e estão associadas ao índice de massa corpórea do receptor maior que 30 kg/m 2 , ao tempo de isquemia fria do pâncreas maior que 24 horas e à causa de morte cerebral do doador que não seja atribuída a trauma (38).…”

Section: Transplante De Pâncreas E Ilhotas No Dmunclassified

“…Os principais fatores envolvidos na rejeição crônica incluem, além da rejeição aguda, a infecção por citomegalovírus, o retransplante, a modalidade de transplante pancreático (solitário versus simultâneo pâncreas/rim) e uma ou duas incompatibilidades no loci B do Human Leucocyte Antigens (HLA) (37).…”

Section: Transplante De Pâncreas E Ilhotas No Dmunclassified

Transplante de pâncreas e ilhotas em portadores de diabetes melito

Sá

Gonzalez

Melaragno

et al. 2008

Arq Bras Endocrinol Metab

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O transplante simultâneo de pâncreas/rim tem indicações específicas, riscos e benefícios. O procedimento, cada vez mais realizado, traz vantagens se comparado ao paciente em diálise, em relação à qualidade de vida, anos de vida ganhos e evolução das complicações crônicas. Se o paciente tiver a opção de realizar o transplante de rim com doador vivo, que apresenta sobrevida semelhante do enxerto e do paciente aos dez anos, o procedimento deverá ser considerado. O transplante de pâncreas após rim, quando efetivo, pode melhorar a evolução das complicações cardiovasculares, mas em contrapartida provoca maior mortalidade nos primeiros meses após a cirurgia. O transplante isolado de pâncreas também ocasiona a maior mortalidade pós-operatória, resultado da complexidade do procedimento e da imunossupressão. O transplante de ilhotas tem sua indicação para um seleto grupo de diabéticos com instabilidade glicêmica.

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Chronic rejection: the next major challenge for pancreas transplant recipients

Abstract: As short-term pancreas transplant results improve and as isolated (PAK or PTA) pancreas transplants gain in popularity, CR will become increasingly common as a cause of pancreas graft loss.

Cited by 76 publications

References 17 publications

Pancreas Transplantation: Lessons Learned From a Decade of Experience at Wake Forest Baptist Medical Center

Pancreas Transplantation: Lessons Learned From a Decade of Experience at Wake Forest Baptist Medical Center

Combined ‘En Bloc’ Liver and Pancreas Transplantation in Patients with Liver Disease and Type 1 Diabetes Mellitus

Transplante de pâncreas e ilhotas em portadores de diabetes melito

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