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

Sutherland, David E.R.; Gruessner, R.; Dünn, David L.; Matas, Arthur J.; Humar, Abhinav; Kandaswamy, Raja; Mauer, S. Michael; Kennedy, William R.; Goetz, Frederick C.; Robertson, R. Paul; Gruessner, Angelika C.; Najarían, John S.

doi:10.1097/00000658-200104000-00003

Cited by 612 publications

(498 citation statements)

References 235 publications

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“…We considered only patients transplanted after 1994 to reflect outcomes using current practices (12,13). Nevertheless, fewer than half of US kidney transplant centers perform SPK for type 1 diabetic patients with ESRD.…”

Section: Discussionmentioning

confidence: 99%

Kidney Allograft and Patient Survival in Type I Diabetic Recipients of Cadaveric Kidney Alone Versus Simultaneous Pancreas/Kidney Transplants

Bunnapradist

Cho²,

Cecka³

et al. 2003

Journal of the American Society of Nephrology

104

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Abstract. Simultaneous pancreas-kidney transplant (SPK) is now a common treatment for insulin-dependent diabetic patients with end-stage renal disease. Renal graft survival rates after SPK have been less well studied. This study compared the kidney survival results for 3642 SPK and 2374 cadaveric renal transplants (CRT) in type I diabetic patients at 112 US transplant centers reported to UNOS during 1994 through 1997. The analysis included follow-up information through September 2000. The kidney graft survival rates were significantly lower among recipients of CRT compared with SPK recipients (P Ͻ 0.001). Patients who received SPK were younger, less often sensitized, transplanted after shorter periods on dialysis, and less often black. The donors of SPK organs were younger, more often died from head trauma, were less often female, and more often black. SPK renal grafts were transplanted with a shorter cold ischemia time to more poorly HLA-matched recipients. After adjustment of these and other factors, whether a patient was recipient of CRT or SPK was not associated with increased risk of kidney graft failure or patient death. SPK recipients experienced half the rate of delayed kidney function (11% versus 23%) but nearly double the rate of rejections during the initial hospitalization (15% versus 9%) compared with CRT recipients. SPK was associated with better renal allograft survival compared with CRT, despite a higher rate of renal allograft rejection. This observation was explained by favorable donor and recipient factors in the SPK group. After controlling for these factors, SPK provided no protective or detrimental effect on short-term renal allograft or patient survival. bunnapradist@cshs.org

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Section: Discussionmentioning

confidence: 99%

Kidney Allograft and Patient Survival in Type I Diabetic Recipients of Cadaveric Kidney Alone Versus Simultaneous Pancreas/Kidney Transplants

Bunnapradist

Cho²,

Cecka³

et al. 2003

Journal of the American Society of Nephrology

104

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“…Furthermore, due to the low Pancreas and islet transplantation are the only treatment regimens currently available to achieve a constant insulin-independent normoglycaemic state in patients with Type 1 diabetes mellitus [1,2]. Pancreas allotransplantation is surgically complex and is associated with a high morbidity [3,4,5,6]. For these reayields and low viability of the isolated islets, tissues from multiple donors must be used for each recipient.…”

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confidence: 99%

Stable transplantation results of magnetically retracted islets: a novel method

et al. 2003

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Aims/hypothesis. Large quantities of pure viable donor islets are necessary for clinical transplantation. At present, low yields and low viability of pancreatic islets after transplantation necessitate the use of multiple donors for a single recipient. In this study an improved method for obtaining large quantities of pure viable islets of Langerhans for transplantation was developed in the rat. Methods. Islets of Langerhans were isolated from Albino Oxford rats. The donor pancreata were perfused in situ with iron oxide, which resulted in entrapment of iron particles in the capillaries of the islets. Subsequently, the islets were isolated by magnetic retraction. Islets obtained with this method were compared with islets obtained by density gradient-isolated islets with respect to yields, purity, and insulin production capacity. Islets isolated with the magnetic retraction method were transplanted under the renal capsule of streptozotocin-induced diabetic recipients. Blood-glucose levels in the recipients were monitored for 2 months after transplantation.Results. This method yielded more pure and viable islets than the conventional protocol. No contamination of exocrine tissue was observed after isolation. Furthermore, the islets isolated by magnetic retraction stained strongly positive for insulin during the entire observation period in vitro, and produced high amounts of insulin upon a challenge with glucose. The islets that were obtained by this new protocol were suitable for safe and effective transplantation. Conclusions/interpretation. We have shown that both the quantity and quality of islets obtained with this method were sufficient to induce insulin independence in a diabetic recipient using islets from only one donor. [Diabetologia (2004) 47:55-61]

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“…The morbidity and mortality associated with pancreas or islet transplantation procedures and the adverse effects of the immunosuppressive regimens after pancreas or islet transplantation have been reported. Additionally, mortality in type 1 diabetic patients has recently improved [26][27][28]. Therefore, appropriate selection of candidates for pancreas or islet transplantation is important.…”

Section: Discussionmentioning

confidence: 99%

Assessment of glycemic lability and severity of hypoglycemia in Korean patients with type 1 diabetes

et al. 2011

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Pancreas or islet transplantation is recommended for individuals with type 1 diabetes who present with frequent and severe hypoglycemia and/or severe glycemic lability, despite efforts to optimize glycemic control [1]. For these patients, pancreas or islet transplantation has led to successful treatment of these problems [2][3][4]. Pancreas and islet transplantations have previously been performed in Korea [5,6].Clinicians can judge whether patients with type 1 diabetes have problems with glycemic lability and/or severe hypoglycemia, but it is difficult to quantify the glycemic lability and hypoglycemia.Attempts have been made to quantify both hypoglycemia and glycemic lability to allow for betweenAssessment of glycemic lability and severity of hypoglycemia in Korean patients with type 1 diabetes abstract. Few studies have focused on the quantification of glycemic lability and hypoglycemic events in Asian patients with type 1 diabetes; therefore, we conducted a study to assess glycemic lability and the severity of hypoglycemia in type 1 diabetic patients in Korea. A total of 124 type 1 diabetic patients were enrolled. Several glycemic lability indexes and hypoglycemic indexes were calculated using four-week self-monitoring of blood glucose (SMBG) data. Due to the dependence of the lability index (LI) on the frequency of glucose measurements, we generated a modified LI by dividing by the number of SMBG measurements per day for a given patient. The numbers of patients in our study with a composite hypoglycemic score ≥ 1,047 or LI ≥ 433 mmol/L 2 /h·week -1 , which was found in a previous study to indicate high risk of severe hypoglycemia or lability, were 0 (0%) and 44 (35%), respectively. Compared to previously reported hypoglycemia indexes, the low blood glucose index was lower in our study. However, the glycemic lability indexes were similar to those in previous studies, with the exception of the LI. The modified LI and the average daily risk range (ADRR) showed higher concordance with other glycemic lability indexes than did the LI or mean amplitude of glycemic excursions (MAGE). The results showed that the hypoglycemic indexes in this study population were lower than the results from Ryan et al. Furthermore, the ADRR or modified LI were better measures for high risk of severe lability than were the LI and MAGE.Key words: Glycemic lability, Type 1 diabetes mellitus, Hypoglycemia center comparison as well as to establish standards for pancreas or islet transplantation [7]. Several indexes have been proposed for glycemic lability and hypoglycemia. The most familiar assessment of glycemic lability is the standard deviation (SD) of the glucose profile [8]. However, the SD has limited capacity to identify the extremes of hyperglycemia or hypoglycemia and is affected by the mean glucose [9]. The mean amplitude of glycemic excursions (MAGE) and average daily risk range (ADRR) also measure glucose lability in diabetic patients [10,11]. The MAGE using continuous glucose monitoring is a well-known index of glycemic labil...

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

Cited by 612 publications

References 235 publications

Kidney Allograft and Patient Survival in Type I Diabetic Recipients of Cadaveric Kidney Alone Versus Simultaneous Pancreas/Kidney Transplants

Kidney Allograft and Patient Survival in Type I Diabetic Recipients of Cadaveric Kidney Alone Versus Simultaneous Pancreas/Kidney Transplants

Stable transplantation results of magnetically retracted islets: a novel method

Assessment of glycemic lability and severity of hypoglycemia in Korean patients with type 1 diabetes

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