Pushing the envelope

Sutherland, David E.R.; Radosevich, David M.; Gruessner, Rainer W.G.; Gruessner, Angelika C.; Kandaswamy, Raja

doi:10.1097/mot.0b013e32834ee6e5

Cited by 55 publications

(7 citation statements)

References 80 publications

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“…Typically both organs come from the same donor, although rarely the organs come from separate deceased donors and even less commonly one or both organs come from a living donor. [25][26][27] Pancreas after kidney transplant (PAK) The second type of pancreas transplant is a PAK. The relative advantage of this approach for patients with diabetes and renal failure is to avoid or minimize the morbidity and mortality associated with dialysis therapy by p roviding a living donor kidney transplant followed by a deceased A brief history of pancreas transplantation Kelly and colleagues performed the first successful pancreas transplant in a human at the University of Minnesota, USA, in 1966.…”

Section: Simultaneous Pancreas-kidney Transplant (Spk)mentioning

confidence: 99%

Pancreas transplantation

Dean

Kukla

Stegall

et al. 2017

BMJ

114

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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: Simultaneous Pancreas-kidney Transplant (Spk)mentioning

confidence: 99%

Pancreas transplantation

Dean

Kukla

Stegall

et al. 2017

BMJ

114

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“…Perioperative risks have been described, and observed rates of bleeding and the risk of splenectomy range from 5% to 15%. 5,7 However, less is known about the long-term medical outcomes. By linking the national US donor registry with pharmaceutical fill records, we found that 26.7% of living pancreas donors filled diabetes medications or supplies over a mean post-donation follow-up period of 16 years, including use of insulin or an oral agent in 20%.…”

Section: Discussionmentioning

confidence: 99%

“…These observations led to changes in the center’s criteria for acceptance of living pancreas donors in 1997, incorporating abnormal predonation glucose tolerance tests, a history of gestational diabetes mellitus, or elevated body mass index at the time of donation as exclusion criteria. 7 In a more recent study from the same institution after this policy change, Kumar et al reported that 20% (3/15) of living pancreas donors between 1997 and 2003 had developed PDDM after a mean follow-up period of 5 years by evaluation including glucose tolerance testing; however, only 13% were on diabetic medications at the time of follow-up, while 28% (6/21) of the original cohort were lost to follow-up. 10 An additional 46% (6/15) of the followed pancreas donors were found to have impaired fasting glucose and/or impaired glucose tolerance after metabolic assessment.…”

Section: Discussionmentioning

confidence: 99%

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Diabetes Mellitus in Living Pancreas Donors

et al. 2017

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Background Living donor pancreas transplant is a potential treatment for diabetic patients with end-organ complications. While early surgical risks of donation have been reported, long-term medical outcomes in living pancreas donors are not known. Methods We integrated national Scientific Registry of Transplant Recipients data (1987–2015) with records from a nationwide pharmacy claims warehouse (2005–2015) to examine prescriptions for diabetic medications and supplies as a measure of post-donation diabetes mellitus. To compare outcomes in controls with baseline good health, we matched living pancreas donors to living kidney donors (1:3) by demographic traits and year of donation. Results Among 73 pancreas donors in the study period, 45 were identified in the pharmacy database: 62% women, 84% white, and 80% relatives of the recipient. Over a mean postdonation follow-up period of 16.3 years, 26.7% of pancreas donors filled prescriptions for diabetes treatments, compared with 5.9% of kidney donors (odds ratio [OR] 4.13, 95% confidence interval [CI] 1.91–8.93; P = 0.0003). Use of insulin (11.1% vs. 0%) and oral agents (20.0% vs. 5.9%; OR 4.50, 95% CI 2.09–9.68; P = 0.0001) was also higher in pancreas donors. Conclusion Diabetes is more common after living pancreas donation than after living kidney donation, supporting clinical consequences from reduced endocrine reserve.

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“…According to the Scientific Registry of Transplant Recipients (SRTR), the 1-year rate of graft survival is 86% when a pancreas and a kidney are transplanted together (SPK), 82% when pancreas is transplanted after kidney (PAK) and 75% when pancreas is transplanted alone. Most pancreatic grafts are from cadaveric donors, though transplantation of a segment of the pancreas donated by a living donor has also been reported (6). Transplantation, however, requires major surgery and dependence on life-long immunosuppression to prevent graft rejection.…”

Section: Therapeutic Options For Type 1 Diabetesmentioning

confidence: 99%

Design of a Bioartificial Pancreas

Pareta¹,

Farney²,

Opara³

2013

Pathobiology

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Islet transplantation has been shown to be a viable treatment option for patients afflicted with type 1 diabetes. However, the lack of availablity of human pancreases and the need to use risky immunosuppressive drugs to prevent transplant rejection remain two major obstacles to the routine use of islet transplantation in diabetic patients. Successful development of a bioartificial pancreas using the approach of microencapsulation with perm-selective coating of islets in hydrogels for graft immunoisolation holds tremendous promise for diabetic patients because it has great potential to overcome these two barriers. In this review article, we will discuss the need for a bioartificial pancreas, provide a detailed description of the microencapsulation process, and review the status of the technology in clinical development. We will also critically review the various factors that will need to be taken into consideration in order to achieve the ultimate goal of routine clinical application.

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Pushing the envelope

Cited by 55 publications

References 80 publications

Pancreas transplantation

Pancreas transplantation

Diabetes Mellitus in Living Pancreas Donors

Design of a Bioartificial Pancreas

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