Living donor pancreas transplantation in Japan

Abstract

Background/purpose Living-donor pancreas transplants (LDPs) were introduced at Chiba-East National Hospital in 2004, and 12 LDPs have been performed at this institution to date. Based on the outcome of these 12 LDPs, the efficacy and safety of LDPs are herein discussed. Methods Twelve diabetic patients underwent LDPs; ten had simultaneous pancreas and kidney transplants from living donors, one had pancreas transplant after a kidney transplant from a living donor, and one had a pancreas transplant alone from a living donor. The donors were parents or brothers and the ABO blood types were incompatible in three LDPs. The procedures for the donor and recipient operations were performed according to the technique established by the University of Minnesota. Bladder drainage was used in 11 recipients and enteric drainage was used in one patient. Tacrolimus, basiliximab, mycophenolate mofetil, and prednisone were used for induction and immunosuppressive treatment. A splenectomy, double-filtered plasmapheresis, and plasma exchange were added in the ABO-incompatible LDPs.

Pancreas Transplantation From Living Donors: A Single Center Experience of 20 Cases

“…LDPT shows better graft survival than DDPT due to the immunologic advantages over technical difficulty (2,4,7). However, after the introduction of tacrolimus, the graft survival rate of DDPT improved remarkably and showed results comparable with those for LDPT (4,7).…”

“…This reflects the high technical difficulty of LDPT due to the relatively small size of the splenic artery and vein. In early LDPT cases, technical failure was a problem; however, this was overcome by technical improvements and declined gradually over time (5,7). In patients with minimal risk of surgical complications, LDPT should not be avoided as a DM treatment for technical reasons.…”

“…In kidney transplantation, it has been already proven that the use of an organ from a living donor (LD) not only increases the number of transplants, but also shows excellent graft survival rates compared to a DD (2,8). However, because LDPT is technically more difficult and may be associated with increased donor morbidity (including the development of DM and surgical complications), its performance has been limited (2,7).…”

“…LDPT has several advantages over deceased donor pancreas transplantation (DDPT), including better HLA matching, shorter ischemic and waiting times, less need for immunosuppression, and a lower risk of infection (7). Furthermore, the shortage of DDs and improved graft outcomes for LDPT can be an attractive treatment for DM patients with or without end-stage renal disease (ESRD) (2,7).…”

“…Furthermore, the shortage of DDs and improved graft outcomes for LDPT can be an attractive treatment for DM patients with or without end-stage renal disease (ESRD) (2,7). In kidney transplantation, it has been already proven that the use of an organ from a living donor (LD) not only increases the number of transplants, but also shows excellent graft survival rates compared to a DD (2,8).…”