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Pancreas transplantation

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Title: Pancreas transplantation  
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Subject: Organ transplantation, Allotransplantation, Liver transplantation, Intestine transplantation, List of MeSH codes (E04)
Collection: Accessory Digestive Gland Surgery, Organ Transplantation
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Pancreas transplantation

Pancreas transplantation
Intervention
Pancreas transplant ex-situ prepared with reconstruction of arteries and lengthening of the portal vein
ICD-9-CM 52.8
MeSH
MedlinePlus

A pancreas transplant is an

  • VIDEO - Last 10 years of pancreas transplantation, by Dixon Kaufman, MD, PhD. University of Wisconsin School of Medicine and Public Health, 2011.
  • Diabetes Institute for Immunology and Transplantation
  • International Pancreas and Islet Transplant Association
  • Pancreas transplantation at the University of Illinois at Chicago

External links

  • Larsen JL (2004). "Pancreas transplantation: indications and consequences". Endocr Rev 25 (6): 919–46.   Full text

Further reading

  1. ^ Type 1 cures - pancreas transplants
  2. ^ Gruesomer AC, Sutherland DE (2005). "Pancreas transplant outcomes for United States (US) and non-US cases as reported to the United Network for Organ Sharing (UNIS) and the International Pancreas Transplant Registry (SCRIPT) as of June 2004". Clint Transplant 19 (4): 433–55.  
  3. ^ Farney, Alan; Cho E; Schweitzer EJ; Dunkin B; Philosophe B; Colonna J; Jacobs S; Jarrell B; Flowers JL; Bartlett ST (November 2000). "Simultaneous cadaver pancreas living-donor kidney transplantation: a new approach for the type 1 diabetic uremic patient.". Annals of Surgery 232 (5): 696–703.  
  4. ^ Fishman JA, Rubin RH (1998). "Infection in organ-transplant recipients". N Engl J Med 338 (24): 1741–51.   Full text
  5. ^ Montero, N; Webster, AC; Royuela, A; Zamora, J; Crespo Barrio, M; Pascual, J (Sep 15, 2014). "Steroid avoidance or withdrawal for pancreas and pancreas with kidney transplant recipients.". The Cochrane database of systematic reviews 9: CD007669.  
  6. ^ Kelly WD, Lillehei RC, Merkel FK, Idezuki Y, Goetz FC (1967). "Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy". Surgery 61 (6): 827–37.  

References

The first pancreas transplantation was performed in 1966 by the team of Dr. Kelly, Dr. Lillehei, Dr. Merkel, Dr. Idezuki Y, & Dr. Goetz, three years after the first kidney transplantation.[6] A pancreas along with kidney and duodenum was transplanted into a 28-year-old woman and her blood sugar levels decreased immediately after transplantation, but eventually she died three months later from pulmonary embolism. In 1979 the first living-related partial pancreas transplantation was done.

History

It is unclear if steroids, which are often used as immunosuppressant, can be replaced with something else.[5]

The prognosis after pancreas transplantation is very good. Over the recent years, long-term success has improved and risks have decreased. One year after transplantation more than 95% of all patients are still alive and 80-85% of all pancreases are still functional. After transplantation patients need lifelong immunosuppression. Immunosuppression increases the risk for a number of different kinds of infection[4] and cancer.

Prognosis

Standard practice is to replace the donor's blood in the pancreatic tissue with an ice-cold organ storage solution, such as UW (Viaspan) or HTK until the allograft pancreatic tissue is implanted.

Preservation until implantation

  • Pancreas transplant alone, for the patient with type 1 diabetes who usually has severe, frequent hypoglycemia, but adequate kidney function.
  • Simultaneous pancreas-kidney transplant (SPK), when the pancreas and kidney are transplanted simultaneously from the same deceased donor.
  • Pancreas-after-kidney transplant (PAK), when a cadaveric, or deceased, donor pancreas transplant is performed after a previous, and different, living or deceased donor kidney transplant.
  • Simultaneous deceased donor pancreas and live donor kidney (SPLK) has the benefit of lower rate of delayed graft function than SPK and significantly reduced waiting times, resulting in improved outcomes.[3]

There are four main types of pancreas transplantation:

Types

Complications immediately after surgery include immunosuppressive drugs. Drugs are taken in combination consisting normally of cyclosporine, azathioprine and corticosteroids. But as episodes of rejection may reoccur throughout a patient's life, the exact choices and dosages of immunosuppressants may have to be modified over time. Sometimes tacrolimus is given instead of cyclosporine and mycophenolate mofetil instead of azathioprine.

Complications

In most cases, pancreas transplantation is performed on individuals with type 1 diabetes with end-stage renal disease, brittle diabetes and hypoglycaemia unawareness. The majority of pancreas transplantation (>90%) are simultaneous pancreas-kidney transplantation.[2] It may also be performed as part of a kidney-pancreas transplantation.

Medical uses

Contents

  • Medical uses 1
  • Complications 2
  • Types 3
  • Preservation until implantation 4
  • Prognosis 5
  • History 6
  • References 7
  • Further reading 8
  • External links 9

) are usually not eligible for valuable pancreatic transplantations, since the condition usually has a very high mortality rate and the disease, which is usually highly malignant and detected too late to treat, could and probably would soon return. insulinomas or pancreatic pancreatic neuroendocrine tumors- which are usually always malignant, with a poor prognosis and high risk for metastasis- as opposed to more treatable pancreatic adenomas (pancreatic cancer At present, pancreas transplants are usually performed in persons with insulin-dependent diabetes, who can develop severe complications. Patients with the most common- and deadliest- form of [1]

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