Mortality Assessment for Pancreas Transplants

Gruessner, Rainer W.G.; Sutherland, David E.R.; Gruessner, Angelika C.

doi:10.1111/j.1600-6143.2004.00667.x

Cited by 301 publications

(220 citation statements)

References 28 publications

(39 reference statements)

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“…Both transplantation options can be conducted alone or in combination with a kidney. Whereas simultaneous pancreaskidney (SPK) transplantation is an intervention with proven benefits in terms of survival (4), conflicting results in pancreas transplantation alone have been published (5,6).…”

mentioning

confidence: 99%

Glycemic Control in Simultaneous Islet-Kidney Versus Pancreas-Kidney Transplantation in Type 1 Diabetes: A Prospective 13-Year Follow-up

Lehmann¹,

Graziano²,

Brockmann

et al. 2015

Diabetes Care

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OBJECTIVEIn patients with type 1 diabetes and end-stage renal disease, combined transplantation of a kidney together with a pancreas or isolated pancreatic islets are options to improve glycemic control. The aim of this study was to compare their long-term outcome with regard to metabolic control and surgical complication rate, as well as function of the transplanted kidney. RESEARCH DESIGN AND METHODSWe conducted a prospective cohort study in consecutive patients receiving either a pancreas or islet transplant simultaneously with or after kidney transplantation (simultaneous pancreas-kidney [SPK]/pancreas-after-kidney [PAK] or simultaneous islet-kidney [SIK]/islet-after-kidney [IAK] transplantation). RESULTSNinety-four patients who had undergone SPK/PAK transplantation were compared with 38 patients who had undergone SIK/IAK transplantation over a period of up to 13 years. HbA 1c levels declined from 7.8 6 1.3% (62 6 14 mmol/mol) to 5.9 6 1.1% (41 6 12 mmol/mol), and from 8.0 6 1.3% (64 6 14 mmol/mol) to 6.5 6 1.1% (48 6 12 mmol/mol), respectively, in the SPK/PAK and SIK/IAK groups (P < 0.001 for both) and remained stable during follow-up, despite a reduction in the rate of severe hypoglycemia by >90%. The 5-year insulin independence rate was higher in the SPK/PAK group (73.6 vs. 9.3% in the SIK/IAK group), as was the rate of relaparotomy after transplantation (41.5 vs. 10.5% in the SIK/IAK group). There was no difference in the rate of kidney function decline. CONCLUSIONSDuring a long-term follow-up, SPK/PAK transplantation as well as SIK/IAK transplantation resulted in a sustained improvement of glycemic control with a slightly higher glycated hemoglobin level in the SIK/IAK group. While insulin independence is more common in whole-organ pancreas recipients, islet transplantation can be conducted with a much lower surgical complication rate and no difference in kidney function decline.

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mentioning

confidence: 99%

Glycemic Control in Simultaneous Islet-Kidney Versus Pancreas-Kidney Transplantation in Type 1 Diabetes: A Prospective 13-Year Follow-up

Lehmann¹,

Graziano²,

Brockmann

et al. 2015

Diabetes Care

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“…Estes dados parecem ser, entre outros, o resultado de avanços nas técnicas cirúrgicas e nos imunossupressores. Em relação a anos de vida ganhos em pacientes submetidos ao transplante isolado de pâncreas e pâncreas após rim, os estudos não mostraram vantagens em relação aos pacientes que permaneceram na lista de espera (26,27).…”

Section: Esquema De Imunossupressãounclassified

Transplante de pâncreas e ilhotas em portadores de diabetes melito

Sá

Gonzalez

Melaragno

et al. 2008

Arq Bras Endocrinol Metab

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O transplante simultâneo de pâncreas/rim tem indicações específicas, riscos e benefícios. O procedimento, cada vez mais realizado, traz vantagens se comparado ao paciente em diálise, em relação à qualidade de vida, anos de vida ganhos e evolução das complicações crônicas. Se o paciente tiver a opção de realizar o transplante de rim com doador vivo, que apresenta sobrevida semelhante do enxerto e do paciente aos dez anos, o procedimento deverá ser considerado. O transplante de pâncreas após rim, quando efetivo, pode melhorar a evolução das complicações cardiovasculares, mas em contrapartida provoca maior mortalidade nos primeiros meses após a cirurgia. O transplante isolado de pâncreas também ocasiona a maior mortalidade pós-operatória, resultado da complexidade do procedimento e da imunossupressão. O transplante de ilhotas tem sua indicação para um seleto grupo de diabéticos com instabilidade glicêmica.

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“…This recommendation is the result of the beneficial effects observed in terms of quality of life and survival after kidneypancreas transplantation into patients suffering for DMT1 (Reddy et al, 2003). However since the procedure of pancreas transplantation has an high incidence of mortality and morbidity (Gruessner et al, 2004) it can be proposed only to selected population of patients candidate to kidney transplantation for diabetic nephropathy. In this the European Trial of Immunosuppression in Simultaneous Pancreas Kidney Transplantation (EUROSPK) study group reported that repeated laparotomies in the first 3 months after transplantation were performed in 35% of all the patients.…”

Section: Combined Kidney-islet Transplantation: Indicationsmentioning

confidence: 99%