Pancreas Transplantation for Diabetes

Sutherland, D; Goetz, F. C.; Najarian, J. S.; Salaman, J. R.

doi:10.1016/s0140-6736(88)91912-5

Cited by 6 publications

(1 citation statement)

References 9 publications

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“…Nevertheless, critics of the results of pancreas transplantation have expressed negative opinions as to its ultimate utility, as typified by Pyke (23), who stated, "Until a clearly argued proposal for a controlled trial of pancreas transplantation is put forward which confronts the problems raised here I find it difficult to see justification for its use in the treatment of diabetes." Sutherland et al (24), who are in the vanguard of evaluating pancreas transplantations, responded to Pyke by agreeing that "ideally pancreas transplantation should be done before the complications of diabetes emerge. Such an approach has not yet been adopted because there are no clear markers to predict, before early lesions appear, which patients are prone to complications; transplantation at this stage would subject some patients to side-effects of immunosuppression more severe than their problems with diabetes would have been."…”

Section: Results Of Sustained Euglycemia Afforded By Whole-organ Pancmentioning

confidence: 99%

Toward a hybrid Artificial Pancreas

Friedman

1989

Diabetes Care

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Management of insulinopenic diabetic individuals centers on administration of insulin by means of multiple injections, a wearable or implantable insulin-infusion pump, or a whole-organ or segmental-pancreas transplant. Preliminary trials indicate that surgical implantation of a hybrid device containing living insulin-secreting tissue may function as a combined glucose sensor and insulin-infusion pump. By means of a chamber composed of a semipermeable membrane shaped into hollow fibers or a box surrounding endocrine tissue, pilot studies have shown that isolated islets of Langerhans, fragments of insulinoma, or a fetal pancreas retains function for days to weeks, as judged by the ability to sustain euglycemic conditions in chemically induced diabetic rats. Lacking clear proof that normalizing blood glucose levels will prevent vascular complications of diabetes in humans, the case for further development of a hybrid (tissue plus fabricated components) device rests mainly on optimistic extrapolation of results attained in the chemically induced diabetic rat and dog. For the minority of diabetic patients who have insulin-dependent diabetes, the benefit afforded by a bionic device establishing internal insulin release regulated by silently sensed blood glucose level is more than enough payoff for the discomfort and surgery involved in its implantation. Further trials of a hybrid artificial pancreas in the dog appear warranted as a logical extension of preliminary studies with this species.

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Section: Results Of Sustained Euglycemia Afforded By Whole-organ Pancmentioning

confidence: 99%

Toward a hybrid Artificial Pancreas

Friedman

1989

Diabetes Care

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Pancreas transplantation

Pyke

1991

Diabetes Metab. Rev.

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Prognostic risk factors for graft failure following pancreas transplantation: results of multivariate analysis of data from the International Pancreas Transplant Registry

1990

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A multivariate analysis of prognostic factors for graft failure was performed on patients in the International Pancreas Transplant Registry. The analysis was restricted to the period January 1978 to June 1987 and included 764 patients. All patients had at least 1 year of follow-up. The following variables were studied: transplant year, continent (N. America, Europe, others), type of donor (cadaver, living related mismatched, living related HLA-identical), donor mismatch at the HLA A, B loci, donor mismatch at the DR loci, preservation time, kidney association (pancreas transplant alone, simultaneous pancreas and kidney transplant, pancreas after kidney transplant), whole versus segmental pancreatic transplant, graft duct management technique (polymer injection, enteric drainage, stomach drainage, bladder drainage), and immunosuppression. By stepwise, logistic regression analysis, we found that the following factors were predictive for 1-year graft function: donor mismatch at the DR loci (P = 0.0003), kidney association (P less than 0.0001), type of donor (P = 0.04), and immunosuppression (P = 0.0002). For donor mismatch at the DR loci, we found an odds ratio for success of 2.2 for 0 versus 2 mismatches. The odds for success were 2.9 for simultaneous pancreas and kidney transplant versus pancreas transplant alone. The best results--79% 1-year graft survival--were obtained for the combination of 0 mismatches at the DR loci, pancreas after kidney transplant, living related HLA-identical donor, and the immunosuppressive regimen consisting of cyclosporin, azathioprine, and prednisone. Patients receiving a pancreas transplant alone with 0 mismatches at the DR loci, living related HLA-identical donor, and triple immunosuppressive regimen had a predicted 1-year graft survival of 71%.

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Pancreas Transplantation for Diabetes

Cited by 6 publications

References 9 publications

Toward a hybrid Artificial Pancreas

Toward a hybrid Artificial Pancreas

Pancreas transplantation

Prognostic risk factors for graft failure following pancreas transplantation: results of multivariate analysis of data from the International Pancreas Transplant Registry

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