Experience with pancreas transplants from living related donors

Sutherland, David E.R.; Goetz, Frederick C.; Kendall, David M.; Robertson, R. Paul; Gillingham, K.; Moudry-Munns, K.; Najarían, John S.

doi:10.1007/978-94-011-3386-9_50

Cited by 5 publications

(5 citation statements)

References 7 publications

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“…Initially, we did only solitary pancreas transplants (PAK or PTA) from an LD, with the main aim being an improvement in results. Through the 1980s our solitary pancreas transplant results were superior with LDs [31].…”

Section: Living Segmental Donor Pancreas Transplantsmentioning

confidence: 94%

“…Thus, nearly all groups now use pancreaticoduodenal grafts from cadaver donors. Segmental grafts continue to be done, but primarily for pancreata procured from living donors [31]. Pancreas transplants from living donors were first done at the University of Minnesota in 1979 [32], primarily as a solitary procedure at a time when the rejection rate for cadaver grafts was high [33].…”

Section: Historymentioning

confidence: 99%

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Pancreas Transplantation for Treatment of Diabetes Mellitus

2001

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Pancreas transplantation is the only treatment for type I diabetes mellitus that can induce an insulin-independent normoglycemic state. Because of the need for immunosuppression, it has been most widely applied in uremic diabetic recipients of kidney transplant with a high success rate, particularly when done as a simultaneous (SPK) procedure (insulin independence > 80% at 1 year) with patient and kidney graft survival rates equivalent to or higher than in those who receive a kidney transplant alone. The results of solitary pancreas transplants (PAK in nephropathic diabetic recipients or PTA in nonuremic recipients) have also dramatically improved; 1-year graft survival rates are more than 80% and 70%, respectively, with the new immunosuppressants tacrolimus and mycophenolate mofetil. Multiple factors are important for successful application of pancreas transplantation, as summarized in this review.

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Section: Living Segmental Donor Pancreas Transplantsmentioning

confidence: 94%

Section: Historymentioning

confidence: 99%

Pancreas Transplantation for Treatment of Diabetes Mellitus

2001

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“…Living donors were used for 6% of the transplants in era 2, predominately in recipients of solitary pancreas transplants (12% of cases equally distributed in the PAK and PTA categories). 86 The incentive for solitary pancreas transplants with living donors lessened as the results of cadaver pancreas transplants improved and waiting times became short by the use of outside donors. …”

mentioning

confidence: 99%

Lessons Learned From More Than 1,000 Pancreas Transplants at a Single Institution

Sutherland¹,

Gruessner²,

Dünn³

et al. 2001

Annals of Surgery

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611

434

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ObjectiveTo determine outcome in diabetic pancreas transplant recipients according to risk factors and the surgical techniques and immunosuppressive protocols that evolved during a 33-year period at a single institution. Summary Background DataInsulin-dependent diabetes mellitus is associated with a high incidence of management problems and secondary complications. Clinical pancreas transplantation began at the University of Minnesota in 1966, initially with a high failure rate, but outcome improved in parallel with other organ transplants. The authors retrospectively analyzed the factors associated with the increased success rate of pancreas transplants. MethodsFrom December 16, 1966, to March 31, 2000, the authors performed 1,194 pancreas transplants (111 from living donors; 191 retransplants): 498 simultaneous pancreas-kidney (SPK) and 1 simultaneous pancreas-liver transplant; 404 pancreas after kidney (PAK) transplants; and 291 pancreas transplants alone (PTA). The analyses were divided into five eras: era 0, 1966 to 1973 (n ϭ 14), historical; era 1, 1978 to 1986 (n ϭ 148), transition to cyclosporine for immunosuppression, multiple duct management techniques, and only solitary (PAK and PTA) transplants; era 2, 1986 to 1994 (n ϭ 461), all categories (SPK, PAK, and PTA), predominately bladder drainage for graft duct management, and primarily triple therapy (cyclosporine, azathioprine, and prednisone) for maintenance immunosuppression; era 3, 1994 to 1998 (n ϭ 286), tacrolimus and mycophenolate mofetil used; and era 4, 1998 to 2000 (n ϭ 275), use of daclizumab for induction immunosuppression, primarily enteric drainage for SPK transplants, pretransplant immunosuppression in candidates awaiting PTA. ResultsPatient and primary cadaver pancreas graft functional (insulinindependence) survival rates at 1 year by category and era were as follows: SPK, era 2 (n ϭ 214) versus eras 3 and 4 combined (n ϭ 212), 85% and 64% versus 92% and 79%, respectively; PAK, era 1 (n ϭ 36) versus 2 (n ϭ 61) versus 3 (n ϭ 84) versus 4 (n ϭ 92), 86% and 17%, 98% and 59%, 98% and 76%, and 98% and 81%, respectively; in PTA, era 1 (n ϭ 36) versus 2 (n ϭ 72) versus 3 (n ϭ 30) versus 4 (n ϭ 40), 77% and 31%, 99% and 50%, 90% and 67%, and 100% and 88%, respectively. In eras 3 and 4 combined for primary cadaver SPK transplants, pancreas graft survival rates were significantly higher with bladder drainage (n ϭ 136) than enteric drainage (n ϭ 70), 82% versus 74% at 1 year (P ϭ .03). Increasing recipient age had an adverse effect on outcome only in SPK recipients. Vascular disease was common (in eras 3 and 4, 27% of SPK recipients had a pretransplant myocardial infarction and 40% had a coronary artery bypass); those with no vascular disease had significantly higher patient and graft survival rates in the SPK and PAK categories. Living donor segmental pancreas transplants were associated with higher technically successful graft survival rates in each era, predominately solitary (PAK and PTA) in eras 1 and 2 and SPK in eras 3 and 4. Diabetic seconda...

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“…The initial rationale for living donor pancreas transplants was to reduce the incidence of rejection [1,55,56], and that objective was achieved [64] but more so for PAK than PTA recipients in the precyclosporine (1978-84) era. Pancreas graft survival rates for technically successful cases were higher with living donors than deceased donors even in the early part of the Minnesota series [55,64], but more so for PAK than PTA transplants, primarily because the rejection rates were very low for same donor living donor PAK transplants [95,102]. Pancreas graft survival rates for technically successful cases were higher with living donors than deceased donors even in the early part of the Minnesota series [55,64], but more so for PAK than PTA transplants, primarily because the rejection rates were very low for same donor living donor PAK transplants [95,102].…”

Section: Perspectivesmentioning

confidence: 99%

Pushing the envelope

Sutherland

Radosevich

Gruessner

et al. 2012

Current Opinion in Organ Transplantation

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The incentives for living donor transplants are to eliminate long-wait times for a deceased donor organ and to improve outcomes. With both the incentive is high, but either by itself is sufficient. As the number of pancreas transplant candidates increase, so will wait times for a deceased donor organ. For this reason, living donor pancreas/islet transplant volume will likely increase in the years to come.

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Experience with pancreas transplants from living related donors

Cited by 5 publications

References 7 publications

Pancreas Transplantation for Treatment of Diabetes Mellitus

Pancreas Transplantation for Treatment of Diabetes Mellitus

Lessons Learned From More Than 1,000 Pancreas Transplants at a Single Institution

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