Long-term Glucose Control in Patients with Pancreatic Transplants

Morel, Philippe; Goetz, Frederick C.; Moudry-Munns, K.; Freier, Esther F.; Sutherland, David E.R.

doi:10.7326/0003-4819-115-9-694

Cited by 64 publications

(22 citation statements)

References 26 publications

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“…54 The metabolic profile and glucose tolerance test studies were used in era 2 to compare posttransplant endocrine function by duration of pancreas graft preservation 106 and to compare function in recipients who did or did not have reversible rejection episodes. 81 The results were similar regardless of preservation time or occurrence of rejection episodes in recipients with sustained insulin independence; glycosylated hemoglobulin levels, 112 both in the short term 151 and the long term, 114 were normal. Era 2 saw the introduction of more sophisticated metabolic studies using new methods initiated by coauthor R.P.R.…”

Section: Metabolic Studiesmentioning

confidence: 56%

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

Sutherland¹,

Gruessner²,

Dünn³

et al. 2001

Annals of Surgery

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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Section: Metabolic Studiesmentioning

confidence: 56%

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

Sutherland¹,

Gruessner²,

Dünn³

et al. 2001

Annals of Surgery

611

434

View full text Add to dashboard Cite

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“…Several factors associated with successful pancreatic transplantation may help reverse some of the above consequences of IDDM. First, pancreatic transplantation results in normalization of glucose homeostasis and abolition of hyperglycaemia 25 . Second, Cheung et al 6 reported a significant improvement in diabetic microangiopathy after SPK transplantation, including reversal of diameter to normal, an increase in arterial length per area and an improvement in vascular perfusion compared with KTA controls.…”

Section: Discussionmentioning

confidence: 99%

Improved patient survival in recipients of simultaneous pancreas–kidney transplant compared with kidney transplant alone in patients with type 1 diabetes mellitus and end-stage renal disease

Mohan

Safi

Little

et al. 2003

British Journal of Surgery

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“…Either a limitation in the growth capacity oftransplanted islets compared to endogenous pancreatic islets, or an increased death rate overwhelming the growth capacity could lead to continuous loss of beta cell mass and failure ofthe graft. Such factors could help explain the discrepancies between the long-term success of whole pancreas transplantation and the limited survival of islet transplantations in large animals and in humans (3,10,15). However, little is known about the growth capacity and fate oftransplanted beta cells and the factors that modify such events.…”

Section: Introductionmentioning

confidence: 99%

Beta cell mass and growth after syngeneic islet cell transplantation in normal and streptozocin diabetic C57BL/6 mice.

Montaña¹,

Bonner-Weir²,

Weir³

1993

J. Clin. Invest.

187

152

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Long-term Glucose Control in Patients with Pancreatic Transplants

Cited by 64 publications

References 26 publications

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

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

Improved patient survival in recipients of simultaneous pancreas–kidney transplant compared with kidney transplant alone in patients with type 1 diabetes mellitus and end-stage renal disease

Beta cell mass and growth after syngeneic islet cell transplantation in normal and streptozocin diabetic C57BL/6 mice.

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