Pancreas Transplantation in C-Peptide Positive Patients: Does “Type” of Diabetes Really Matter?

Stratta, Robert J.; Rogers, Jeffrey; Farney, Alan C.; Orlando, Giuseppe; Hennawy, Hany M El; Gautreaux, Michael D.; Reeves‐Daniel, Amber; Palanisamy, A.; Iskandar, Samy S.; Bodner, J.

doi:10.1016/j.jamcollsurg.2014.12.020

Cited by 44 publications

(93 citation statements)

References 47 publications

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“…2 However, efficacy has been demonstrated in selected patients with type 2 diabetes. [131][132][133][134] Although most patients with type 2 diabetes are unlikely to be appropriate candidates for pancreas transplantation, a select subset of patients with relatively low insulin requirements would probably benefit from transplantation. The inclusion of such candidates in a prospective cohort study will be instrumental in confirming the efficacy of pancreas transplantation for this condition.…”

Section: Pancreas Transplantation In Type 2 Diabetesmentioning

confidence: 99%

Pancreas transplantation

Dean

Kukla

Stegall

et al. 2017

BMJ

112

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The treatment of patients with diabetes mellitus (DM) presents many challenges to care providers and represents a major proportion of healthcare expenditure worldwide. Successful pancreas transplantation provides durable glycemic control and improves survival for patients with diabetes. Progress in the field has mainly been based on large single center studies and the cumulative analyses of registry data from the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry. This review focuses on the outcomes of pancreas transplantation for patients with and without end stage renal disease. It describes the current state of pancreas transplantation, gaps in knowledge, and future studies needed to enable more patients to benefit from this treatment. A common theme that emerges is the need for multicenter randomized trials in pancreas transplantation to define clearly the efficacy, risks, and long term benefits.

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Section: Pancreas Transplantation In Type 2 Diabetesmentioning

confidence: 99%

Pancreas transplantation

Dean

Kukla

Stegall

et al. 2017

BMJ

112

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show abstract

“…35 After adjusting for other potential risk factors (eg time on dialysis, obesity), however, diabetes type was not identified as an independent prognostic factor. 35 Concerning the role of C-peptide in defining T1DM and T2DM during patient selection, Stratta et al 36 stratified 162 SPK recipients according to pretransplant C-peptide levels into C-peptide 'positive' (≥2.0 ng/mL; n=30) and C-peptide 'negative' (<2.0 ng/mL; n=132) groups. With a mean follow-up duration of 5.6 years, the two groups showed no statistically significant differences in pancreas graft, kidney graft, or patient survival.…”

Section: Indications (In Type 1 Versus Type 2 Diabetes Mellitus)mentioning

confidence: 99%

“…With a mean follow-up duration of 5.6 years, the two groups showed no statistically significant differences in pancreas graft, kidney graft, or patient survival. 36 In a similar study involving 80 SPK recipients, 10 were classified as T2DM and 70 as T1DM. 37 On Cox regression survival analyses, no statistically significant difference in graft and patient survival was found between the two groups.…”

Section: Indications (In Type 1 Versus Type 2 Diabetes Mellitus)mentioning

confidence: 99%

Simultaneous pancreas and kidney transplantation as the standard surgical treatment for diabetes mellitus patients with end-stage renal disease

et al. 2016

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Objectives: To review the outcome following simultaneous pancreas and kidney transplantation in patients with type 1 diabetes mellitus and endstage renal disease, as well as those with type 2 diabetes mellitus, and to discuss the applicability of this treatment in this locality. Methods:A systematic literature review was performed by searching the PubMed and Elsevier databases. The search terms used were "simultaneous pancreas and kidney transplantation", "diabetes", "pancreas transplant" and "SPK". Original and major review articles related to simultaneous pancreas and kidney transplantation were reviewed. Papers published in English after 1985 were included. Clinical outcomes following transplantation were extracted for comparison between different treatment methods. Outcomes of simultaneous pancreas and kidney transplant and other transplantation methods were identified and categorised into patient survival, graft survival, diabetic complications, and quality of life. Patient survivals and graft survivals were also compared. Results

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“…The number of annual pancreas transplants reported to the Eurotransplant Network has similarly declined in the past decade whereas annual activity in the United Kingdom has remained relatively stable and activity elsewhere in the world has increased [1][2][3] . In spite of declining numbers, outcomes have continued to improve and include higher risk groups such as African-Americans, patients with a phenotype suggesting "type 2 diabetes" and solitary pancreas transplant recipients [1][2][3][4][5] . Five year patient survival rates are now nearly 90% across all three transplant types and 10-year patient survival is > 70% in all three groups.…”

Section: Introductionmentioning

confidence: 99%

Exocrine drainage in vascularized pancreas transplantation in the new millennium

El‐Hennawy¹,

Stratta²,

Smith³

2016

WJT

Self Cite

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The history of vascularized pancreas transplantation largely parallels developments in immunosuppression and technical refinements in transplant surgery. From the late-1980s to 1995, most pancreas transplants were whole organ pancreatic grafts with insulin delivery to the iliac vein and diversion of the pancreatic ductal secretions to the urinary bladder (systemic-bladder technique). The advent of bladder drainage revolutionized the safety and improved the success of pancreas transplantation. However, starting in 1995, a seismic change occurred from bladder to bowel exocrine drainage coincident with improvements in immunosuppression, preservation techniques, diagnostic monitoring, general medical care, and the success and frequency of enteric conversion. In the new millennium, pancreas transplants are performed predominantly as pancreatico-duodenal grafts with enteric diversion of the pancreatic ductal secretions coupled with iliac vein provision of insulin (systemic-enteric technique) although the systemic-bladder technique endures as a preferred alternative in selected cases. In the early 1990s, a novel technique of venous drainage into the superior mesenteric vein combined with bowel exocrine diversion (portal-enteric technique) was designed and subsequently refined over the next ≥ 20 years to recreate the natural physiology of the pancreas with firstpass hepatic processing of insulin. Enteric drainage usually refers to jejunal or ileal diversion of the exocrine secretions either with a primary enteric anastomosis or with an additional Roux limb. The portal-enteric technique has spawned a number of newer and revisited techniques of enteric exocrine drainage including duodenal or gastric diversion. Reports in the literature suggest no differences in pancreas transplant outcomes irrespective of type of either venous or exocrine diversion. The purpose of this review is to examine the FIELD OF VISION

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Pancreas Transplantation in C-Peptide Positive Patients: Does “Type” of Diabetes Really Matter?

Cited by 44 publications

References 47 publications

Pancreas transplantation

Pancreas transplantation

Simultaneous pancreas and kidney transplantation as the standard surgical treatment for diabetes mellitus patients with end-stage renal disease

Exocrine drainage in vascularized pancreas transplantation in the new millennium

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