Combined liver-pancreas transplantation: contribution of five cases

Aguirrezabalaga, J.; Gómez, Manuel; Novás, S.; Fernández, C.; Corbal, G.; Fraguela, J.; Bueno, Javier; Suárez, Francisco; Otero, Alejandra

doi:10.1016/s0041-1345(01)02729-4

Cited by 13 publications

(6 citation statements)

References 2 publications

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“…Combined liver‐pancreas transplants are also rare. One series describes a group of 5 patients with various causes of end‐stage liver disease and type II diabetes mellitus who successfully underwent simultaneous but separate liver and pancreas transplants 18. Another case report describes 2 pediatric patients with end‐stage liver disease and type I diabetes mellitus who benefited from en bloc liver‐pancreas transplantation 19…”

Section: Discussionmentioning

confidence: 99%

“…The benefit of the en bloc technique is a simpler operation with fewer anastamoses, along with the possible benefits of the physiologic insulin release into the portal circulation. Possible advantages of the en bloc technique include portal venous drainage, which will increase hepatotrophic insulin flow to the liver and decrease the risk of venous torsion,18 and an immunologic benefit of the liver acting as a sink for circulating antigen and inducing tolerance to pancreatic graft 26, 27. There are no case reports that describe a downside to combined liver‐pancreas transplants, but this fact may represent a reporting bias.…”

Section: Discussionmentioning

confidence: 99%

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Combined en bloc liver pancreas transplantation for children with CF

et al. 2007

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Cystic fibrosis (CF) is an inherited genetic defect in epithelial chloride transport that results a multisystem disease affecting the sweat glands and the pulmonary and digestive systems. Although pulmonary disease remains the primary cause of morbidity and mortality in these patients, up to 8% may develop focal biliary cirrhosis and portal hypertension. Liver transplantation is an accepted therapy for these patients. About 85% of CF patients develop pancreatic exocrine insufficiency and up to 34% will develop diabetes requiring insulin. We describe a series of 9 patients who underwent liver transplantation (6 transplantation of liver only [LO], and 3 combined en bloc liver-pancreas [LP] transplantation) for CF-related liver disease at our institution,. All 9 patients had pretransplant pancreatic exocrine insufficiency requiring enzyme supplementation. Of the 9, 5 patients (55%) had preoperative insulin dependent diabetes, including all 3 patients who underwent liver pancreas transplantation. Liverpancreas transplants were performed en bloc. One-year patient survival for both LO and LP patients was 100%. Five-year patient survival was 83% for the LO patients and 100% for the LP patients. All LP patients are off insulin and do not require pancreatic enzyme supplementation. All patients receiving LO continue to need exogenous pancreatic enzyme supplementation. In the 6 patients who received LO, 2 were insulin dependent prior to surgery, and they remain insulin dependent after transplant. Of the 4 patients who received LO who were not insulin dependent pretransplant, 3 have now developed insulin-dependent diabetes. Patients receiving LO were more likely to be diabetic and require exogenous pancreatic enzymes after transplant than those receiving LP (83% vs. 0%, P ϭ 0.04, and 100% vs. 0%, P ϭ 0.01, respectively). In conclusion, patients with CF and end-stage liver disease requiring liver transplantation may benefit from combined liverpancreas transplantation. Liver Transpl 13: 406-409, 2007.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Combined en bloc liver pancreas transplantation for children with CF

et al. 2007

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“…Recently, the indication for combined liver-pancreas transplantation has been changed and transplant surgeons have started using this technique for patients with insulin dependent diabetes mellitus (IDDM) who are candidates for liver transplantation at the same time. There are several advantages to using simultaneous liver-pancreas transplant such as insulin independence after transplantation, improving patient management, and decreasing the risk of post-transplant cardiovascular diseases[ 2 ]. Diabetic patients who receive only liver graft are not only at increased risk of developing cardiovascular diseases but also remain diabetic after transplantation which may itself negatively affect the long-term graft survival[ 3 - 5 ].…”

Section: Introductionmentioning

confidence: 99%

Simultaneous liver, pancreas-duodenum and kidney transplantation in a patient with hepatitis B cirrhosis, uremia and insulin dependent diabetes mellitus

Guo

Cai

et al. 2017

WJG

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Simultaneous liver, pancreas-duodenum, and kidney transplantation has been rarely reported in the literature. Here we present a new and more efficient en bloc technique that combines classic orthotopic liver and pancreas-duodenum transplantation and heterotopic kidney transplantation for a male patient aged 44 years who had hepatitis B related cirrhosis, renal failure, and insulin dependent diabetes mellitus (IDDM). A quadruple immunosuppressive regimen including induction with basiliximab and maintenance therapy with tacrolimus, mycophenolate mofetil, and steroids was used in the early stage post-transplant. Postoperative recovery was uneventful and the patient was discharged on the 15th postoperative day with normal liver and kidney function. The insulin treatment was completely withdrawn 3 wk after operation, and the blood glucose level remained normal. The case findings support that abdominal organ cluster and kidney transplantation is an effective method for the treatment of end-stage liver disease combined with uremia and IDDM.

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“…Combined heterotopic liver and pancreas transplantation, a standard OLT and heterotopic pancreas transplantation in the right lower quadrant, is an infrequent option for patients with end‐stage liver disease and concurrent DM . Patients may not benefit from the transplantation because the procedure is associated with a higher incidence of complications and a lower longterm pancreas graft survival rate.…”

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confidence: 99%

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

Zhao

et al. 2017

Liver Transpl

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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.

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Combined liver-pancreas transplantation: contribution of five cases

Cited by 13 publications

References 2 publications

Combined en bloc liver pancreas transplantation for children with CF

Combined en bloc liver pancreas transplantation for children with CF

Simultaneous liver, pancreas-duodenum and kidney transplantation in a patient with hepatitis B cirrhosis, uremia and insulin dependent diabetes mellitus

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

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