Pancreas transplantation in non-uremic diabetic recipients

Sutherland, David E.R.; Dünn, David L.; Moudry-Munns, K.; Gillingham, K.; Najarían, John S.

doi:10.1007/978-94-011-3386-9_47

Cited by 11 publications

(24 citation statements)

References 13 publications

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“…We persisted with the philosophy that PTA was the most logical application: why wait for secondary complications? 48 In era 1, the emphasis was on developing the best surgical technique, particularly for duct management. We sequentially used every duct management technique devised (open duct, 1978; duct injection, 1980; enteric drainage, 1981; urinary …”

mentioning

confidence: 99%

“…39 For this reason, we switched to the duct injection and enteric drainage techniques until these were superseded by bladder drainage near the end of era 1. 50,52 Other technical aspects of era 1 included portal venous drainage of segmental pancreas grafts using the interior mesenteric vessels in a few cases, 54 routine procurement of whole pancreas grafts from liver donors 55 with reconstruction of the graft arterial system using a Y graft of donor iliac artery, 56 and development of a reliable method of cold storage of pancreas grafts for more than 24 hours in silica gel-filtered plasma.57,58 The latter was superseded in era 2 by the nonbiologic (eliminating the risk of disease transmission) University of Wisconsin (UW) solution developed by Belzer.14 We also began to do pancreas graft biopsies 59 to help diagnose the cause of graft dysfunction. …”

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confidence: 99%

“…75 From then on, we offered pancreas transplants liberally in all three recipient categories. 76,77 Our basic immunosuppressive regimen (quadruple therapy) at that time consisted of Minnesota antilymphocyte globulin for induction and the combination of cyclosporine, azathioprine, and prednisone for maintenance. 62 We conducted a randomized study of Minnesota antilymphocyte globulin versus OKT3 for induction therapy in KTA and SPK recipients, 78 we substituted antithymocyte globulin (ATGAM) for Minnesota antilymphocyte globulin when the latter became unavailable at the end of 1993, 79 and we instituted anti-T-cell agents as the first line of therapy for all first rejection episodes in pancreas recipients.…”

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confidence: 99%

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

Sutherland¹,

Gruessner²,

Dünn³

et al. 2001

Annals of Surgery

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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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confidence: 99%

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confidence: 99%

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

Sutherland¹,

Gruessner²,

Dünn³

et al. 2001

Annals of Surgery

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611

434

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“…1-3). Whole pancreas transplantation is preferred over segmental transplantation because of the theoretically lower risk of thrombosis in whole grafts, which have a higher blood flow, and because of the larger beta-cell mass available [1].…”

Section: Progress In Radiologymentioning

confidence: 99%

“…1-3). However, revascularization of the graft is occasionally done with anastomoses made to the recipient splenic or inferior mesenteric vessels, permitting the venous effluent to drain into the portal venous system; no metabolic advantage has been shown with these variations [1].…”

Section: Progress In Radiologymentioning

confidence: 99%

Pancreas transplant imaging: an overview.

Low¹,

Kuni²,

Letourneau³

1990

American Journal of Roentgenology

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Beta-cell replacement therapy

Dunn

Kirchner²,

Bellin

2015

Current Opinion in Organ Transplantation

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Purpose of reviewThis article provides a summary of the current outcomes of b-cell replacement strategies, an algorithm for choosing a specific modality while highlighting associated advantages and disadvantages, and outlines remaining challenges and areas of active investigation in b-cell replacement therapy. Recent findingsThe most recent reports of islet cell allotransplantation have shown improvements over previous eras and now rival some outcomes of pancreas alone transplantation. Active areas of investigation are focused on improving techniques for islet isolation, graft monitoring, and managing challenges posed by the innate and alloimmune systems. SummaryPatients with insulin-dependent diabetes who continue to experience life threatening hypoglycemia despite maximal medical management can benefit from b-cell replacement. Emerging nontransplant technologies have not provided a physiologic euglycemic state to the extent offered by transplantation. Islet transplantation eliminates hypoglycemic episodes/unawareness, facilitates normalization of hemoglobin A1c (HbA1c), decreases microvascular disease progression, and improves quality of life for patients with problematic diabetes. Mid-and long-term outcomes of islet transplantation performed at expert centers approximate those of registry reports of solitary pancreas transplant, whereas the complication profile is quite favorable.

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Pancreas transplantation in non-uremic diabetic recipients

Cited by 11 publications

References 13 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

Pancreas transplant imaging: an overview.

Beta-cell replacement therapy

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