The elderly pancreas transplant recipient

Schenker, Peter

doi:10.1111/tri.12771

Cited by 6 publications

(5 citation statements)

References 6 publications

(10 reference statements)

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“…Most patients less than 45 years of age are considered to be acceptable candidates for PTx until proven otherwise, provided that they are not obese and no significant coronary or peripheral vascular disease is present. Patients older than 55 years of age are not candidates until proven otherwise, and need to undergo an extensive cardiovascular and peripheral vascular evaluation [47,48,62,63 & , [64][65][66][67][68][69][70][71][72]. Similarly, for BMI, although there is no absolute cutoff, the transplant operation becomes increasingly difficult with increasing abdominal obesity [73].…”

Section: Inadequate Psychosocial Support and Financial Resourcesmentioning

confidence: 99%

Modern indications for referral for kidney and pancreas transplantation

Fridell

Stratta

2022

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of review Pancreas transplantation (PTx) is currently the only therapy that can predictably achieve sustained euglycemia independent of exogenous insulin administration in patients with insulin-dependent diabetes mellitus. This procedure involves a complex abdominal operation and lifetime dependence on immunosuppressive medications. Therefore, PTx is most frequently performed in combination with other organs, usually a kidney transplant for end stage diabetic nephropathy. Less frequently, solitary PTx may be indicated in patients with potentially life-threatening complications of diabetes mellitus. There remains confusion and misperceptions regarding indications and timing of patient referral for PTx. Recent findings In this review, the referral, evaluation, and listing process for PTx is described, including a detailed discussion of candidate assessment, indications, contraindications, and outcomes. Summary Because the progression of diabetic kidney disease may be less predictable than other forms of kidney failure, early referral for planning of renal and/or pancreas transplantation is paramount to optimize patient care and allow for possible preemptive transplantation.

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Section: Inadequate Psychosocial Support and Financial Resourcesmentioning

confidence: 99%

Modern indications for referral for kidney and pancreas transplantation

Fridell

Stratta

2022

Current Opinion in Nephrology &Amp; Hypertension

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“…Most patients < 45 years of age are considered to be acceptable medical candidates for PTx if they are not obese and have no history of major peripheral vascular or cardiac disease. Patients > 55 years of age are not considered to be acceptable medical candidates for SPKT until proven otherwise; a detailed cardiovascular and peripheral vascular evaluation is required [44,71,[95][96][97][98][99][100][101][102][103][104][105]. Because of a higher rate of surgical complications in obese patients, BMI > 35 kg/m 2 is usually considered a contraindication for SPKT unless the individual either has a favorable body habitus (no central obesity) or is able to lose weight [106][107][108][109][110][111][112][113].…”

Section: Optional Testingmentioning

confidence: 99%

Pancreas Transplantation in Minorities including Patients with a Type 2 Diabetes Phenotype

Stratta

Gruessner

2022

Uro

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Background: Prior to year 2000, the majority of pancreas transplants (PTx) were performed as simultaneous pancreas-kidney transplants (SPKTs) in Caucasian adults with end stage renal failure secondary to type 1 diabetes mellitus (T1DM) who were middle-aged. In the new millennium, improving outcomes have led to expanded recipient selection that includes patients with a type 2 diabetes mellitus (T2DM) phenotype, which excessively affects minority populations. Methods: Using PubMed® to identify appropriate citations, we performed a literature review of PTx in minorities and in patients with a T2DM phenotype. Results: Mid-term outcomes with SPKT in patients with uremia and circulating C-peptide levels (T2DMphenotype) are comparable to those patients with T1DM although there may exist a selection bias in the former group. Excellent outcomes with SPKT suggests that the pathophysiology of T2DM is heterogeneous with elements consisting of both insulin deficiency and resistance related to beta-cell failure. As a result, increasing endogenous insulin (Cp) production following PTx may lead to freedom checking blood sugars or taking insulin, better metabolic counter-regulation, and improvements in quality of life and life expectancy compared to other available treatment options. Experience with solitary PTx for T2DM or in minorities is limited but largely mirrors the trends reported in SPKT. Conclusions: PTx is a viable treatment option in patients with pancreas endocrine failure who are selected appropriately regardless of diabetes type or recipient race. This review will summarize data that unconventional patient populations with insulin-requiring diabetes may gain value from PTx with an emphasis on contemporary experiences and appropriate selection in minorities in the new millennium.

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“…As a result, there has been an increase in SPKT in older patients that has appeared to have leveled off in the past five years. While outcomes in this population are mixed, [10][11][12][13][14][15][16][17][18][19][20][21][55][56][57][58][65][66][67] SPKT is generally supported when disease severity, comorbidity, and likely benefit are considered, rather than age alone. Limitations in the current data include the small number of patients represented in single-center retrospective analyses and the lack of granular information in registry data.…”

Section: Afaneh Et Al Reported On 136 Consecutive Pancreas Transplants 17mentioning

confidence: 99%

“…9 There has been a growing body of literature evaluating outcomes of SPKT in older patients with DM. [10][11][12][13][14][15][16][17][18][19][20][21] Although "older" following kidney transplantation alone usually refers to patients in the age range of ≥65-70 years, [22][23][24][25][26] the definition of "older" following SPKT is considered to be an age range of ≥45-50 years. Although many transplant centers apply age limits of 45-50 years or less for SPKT consideration, there is currently no consensus on a strict chronological age cut-off for candidacy.…”

mentioning

confidence: 99%

“…In this "older" population, potential candidates need to undergo an extensive cardiovascular, peripheral vascular, psychosocial, and functional evaluation in an attempt to determine "physiologic age." [10][11][12][13][14][15][16][17][18][19][20][21][32][33][34][35][36][37][38] The majority of the literature has focused on assessing transplant outcomes in older compared to younger SPKT recipients. The purpose of this study was to retrospectively analyze our single-center experience in 255 SPKT recipients in the modern era (new millennium) in an ethnically diverse population and determine the effects, if any, that recipient age has on short and long-term outcomes.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Recipient age and outcomes following simultaneous pancreas‐kidney transplantation in the new millennium: Single‐center experience and review of the literature

Gurung

Alejo

Rogers

et al. 2021

Clinical Transplantation

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Vascularized pancreas transplantation was first performed successfully in 1966 as a therapeutic modality to recreate autoregulating endogenous insulin secretion and represents a method of complete β-cell replacement that frees the patient with diabetes mellitus (DM) both from the need to monitor serum glucose and from dependence on exogenous insulin administration. 1 Unfortunately, pancreas transplantation entails a major surgical procedure and the necessity for long-term immunosuppression,

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The elderly pancreas transplant recipient

Cited by 6 publications

References 6 publications

Modern indications for referral for kidney and pancreas transplantation

Modern indications for referral for kidney and pancreas transplantation

Pancreas Transplantation in Minorities including Patients with a Type 2 Diabetes Phenotype

Recipient age and outcomes following simultaneous pancreas‐kidney transplantation in the new millennium: Single‐center experience and review of the literature

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