No abstract

The treatment of diabetes mellitus by transplantation of isolated pancreatic islets is an approach that remains the subject of research by a large number of investigators throughout the world. A crucial requirement for the success of this enterprise is the ability to prepare viable isolated islets in adequate quantity. Over the years numerous descriptions of procedures for islet isolation from the pancreas of experimental animals and of man have been advanced; each claiming to be an improvement on previous methods. Indeed, there certainly have been advances, although few techniques live up to the claims that are made in their support Part of the problem is the generally poor methodology

ObjectiveThis study analyzed the incidence and timing of biliary tract complications after orthotopIc liver transplantation (OL Tx) in 1792 consecutive patients. These results were then compared with those of previously reported series. Finally, recommendations were made on appropriate management strategies. Summary Background DataTechnical complications after OL Tx have a significant Impact on patient and graft survival. One of the principle technical advances has been the standardization of techniques for biliary reconstruction. Nonetheless. biliary complications stili occur. A 1983 report from the University of Pittsburgh reported biliary complications in 19% of all transplants, and an update in 1987 reported biliary complications In 13.2% of transplants. MethodsThe medical records of all patients who underwent liver transplantation and were hospitalized between January 1,1988 and July 31.1991 were revieWed. The case matenal conSisted of the medical records of 217 patients treated for 245 biliary complICations. Results Primary biliary continuity was established by either choledochocholedochostomy over a T·tube(C-C, n = 129) or a Roux-en-Y choledochoJeJunostomy With an internal stent (C-RY, n = 85). The overall Incidence for biliary complication in this large senes was 11.5%. Strictures (n = 93) and bile leak (n = 58) were the most common complications (69.6%). Most biliary complications (n = 143, 66%) occurred Within the first 3 months after surgery. In general, leaks occurred early, and strictures developed later. Bile leaks were equally frequent In both C-C and CoRY (27.1 % and 25.9%, respectively): strictures were more common after a CoRY type of reconstruction (36.4% and 52.9%, respectively). Twenty-one patients died, an InCidence of 9.6%. Fifteen of the 21 biliary-related deaths were among patients treated for rejectIOn before the recognition of biliary tract pathologiC findings. 40

Smooth-muscle tumors that developed after organ transplantation contained clonal EBV, suggesting that the virus has a role in the development of these neoplastic lesions.

Transplantation is an effective therapy for the treatment of patients with end-stage intestine failure who cannot tolerate parenteral nutrition. With newer immune suppressive protocols, 1-year graft and patient survival rates approach the results of liver transplantation. Further improvement in survival are expected with early referral since suitable donor organs are scarce and survival rates are better when patients are well enough to wait at home for their transplant.