Enteric conversion after pancreatic transplantation: resolution of symptoms and long‐term results

Kleespies, Axel; Mikhailov, Michael; Khalil, Philipe N.; Preißler, Gerhard; Rentsch, Markus; Arbogast, Helmut; Illner, Wolf–Dieter; Bruns, Christiane; Jauch, Karl‐Walter; Angele, Martin K.

doi:10.1111/j.1399-0012.2010.01363.x

Cited by 22 publications

(14 citation statements)

References 40 publications

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“…Enteric conversion frequency ranged from 10% to 40% (Table 3) [79 -86] . Several authors reported that enteric conversion resulted in superb long-term graft function coupled with marked symptom improvement even when performed several years following SPK transplant [84,87,88] . Despite urological morbidity and the finite risk of enteric conversion, 5-year actuarial patient and graft survival rates with bladder drainage were excellent and most complications could be managed with conservative (nonoperative) therapy.…”

Section: El-hennawy H Et Al Exocrine Drainage In Pancreas Transplantsmentioning

confidence: 99%

Exocrine drainage in vascularized pancreas transplantation in the new millennium

El‐Hennawy¹,

Stratta²,

Smith³

2016

WJT

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The history of vascularized pancreas transplantation largely parallels developments in immunosuppression and technical refinements in transplant surgery. From the late-1980s to 1995, most pancreas transplants were whole organ pancreatic grafts with insulin delivery to the iliac vein and diversion of the pancreatic ductal secretions to the urinary bladder (systemic-bladder technique). The advent of bladder drainage revolutionized the safety and improved the success of pancreas transplantation. However, starting in 1995, a seismic change occurred from bladder to bowel exocrine drainage coincident with improvements in immunosuppression, preservation techniques, diagnostic monitoring, general medical care, and the success and frequency of enteric conversion. In the new millennium, pancreas transplants are performed predominantly as pancreatico-duodenal grafts with enteric diversion of the pancreatic ductal secretions coupled with iliac vein provision of insulin (systemic-enteric technique) although the systemic-bladder technique endures as a preferred alternative in selected cases. In the early 1990s, a novel technique of venous drainage into the superior mesenteric vein combined with bowel exocrine diversion (portal-enteric technique) was designed and subsequently refined over the next ≥ 20 years to recreate the natural physiology of the pancreas with firstpass hepatic processing of insulin. Enteric drainage usually refers to jejunal or ileal diversion of the exocrine secretions either with a primary enteric anastomosis or with an additional Roux limb. The portal-enteric technique has spawned a number of newer and revisited techniques of enteric exocrine drainage including duodenal or gastric diversion. Reports in the literature suggest no differences in pancreas transplant outcomes irrespective of type of either venous or exocrine diversion. The purpose of this review is to examine the FIELD OF VISION

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Section: El-hennawy H Et Al Exocrine Drainage In Pancreas Transplantsmentioning

confidence: 99%

Exocrine drainage in vascularized pancreas transplantation in the new millennium

El‐Hennawy¹,

Stratta²,

Smith³

2016

WJT

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“…There are also favorable results for the conversion of bladder to enteric drainage without increased risk of graft loss [26]. However, when enteric conversion was performed in an emergent situation due to anastomosis leakage, the results could be worse than in the elective cases [1]. In our series, only the patient who underwent enteric conversion with duodenal leakage had recurrent duodenal leaks and peritonitis.…”

Section: Discussionmentioning

confidence: 80%

“…Simultaneous pancreas-kidney (SPK) transplantation is an established therapeutic approach for patients with insulin-dependent diabetes mellitus and end-stage renal disease [1]. Improvement of quality of life and potential reductions in macrovascular and microvascular complications have been documented in many publications [2,3,4].…”

Section: Introductionmentioning

confidence: 99%

Simultaneous pancreas-kidney transplantation: lessons learned from the initial experience of a single center in Korea

et al. 2015

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PurposeThe purpose of this study is to report the results of simultaneous pancreas-kidney (SPK) transplantations and describe the lessons learned from the early experiences of a single center.MethodsBetween January 2002 and June 2013, a total of 8 patients underwent SPK transplantation. Clinical and radiologic data were reviewed retrospectively.ResultsSeven patients were diagnosed with type I diabetes mellitus and one patient became insulin-dependent after undergoing a total pancreatectomy because of trauma. Pancreas exocrine drainage was performed by enteric drainage in 4 patients and bladder drainage in 4 patients. Three patients required conversion from initial bladder drainage to enteric drainage due to urinary symptoms and duodenal leakage. Four patients required a relaparotomy due to hemorrhage, ureteral stricture, duodenal leakage, and venous thrombosis. There was no kidney graft loss, and 2 patients had pancreas graft loss because of venous thrombosis and new onset of type II diabetes mellitus. With a median follow-up of 76 months (range, 2-147 months), the death-censored graft survival rates for the pancreas were 85.7% at 1, 3, and 5 years and 42.9% at 10 years. The patient survival rate was 87.5% at 1, 3, 5, and 10 years.ConclusionThe long-term grafts and patient survival in the current series are comparable to previous studies. A successful pancreas transplant program can be established in a single small-volume institute. A meticulous surgical technique and early anticoagulation therapy are required for further improvement in the outcomes.

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“…При не-возможности адекватной коррекции возможно вы-полнение отсроченной конверсии анастомоза с фор-мированием дуоденоэнтероанастомоза [27,64,68].…”

Section: хирургические аспекты трансплантации поджелудочной железы меunclassified

Pancreas transplantation in the treatment of diabetes mellitus type 1: modern aspects

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2017

RJTAO

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1 ФГБУ «Национальный медицинский исследовательский центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России, Москва, Российская Федерация 2 НИИ урологии и интервенционной радиологии имени Н.А. Лопаткина -филиал ФГБУ «Национальный медицинский исследовательский радиологический центр» Минздрава России, Москва, Российская Федерация Сахарный диабет является социально значимым заболеванием. В Российской Федерации распространен-ность сахарного диабета 1-го типа составляет 340 тысяч человек, причем около 21% пациентов имеют явления диабетической нефропатии, а также других вторичных осложнений, приводящих к инвалиди-зации и высокой смертности. Существует несколько вариантов заместительной терапии для больных диабетом с терминальной почечной недостаточностью: инсулинотерапия в сочетании с диализом или трансплантацией почки, комбинированная трансплантация почки и поджелудочной железы или ее ос-тровковых клеток. Только трансплантация целой поджелудочной железы в сочетании с трансплантаци-ей почки может обеспечить лучшие отдаленные результаты за счет максимальной нормализации мета-болизма в сравнении с другими видами заместительной терапии. Существенной составляющей успеха трансплантации является тщательная селекция реципиентов с особым вниманием к состоянию сердечно-сосудистой системы. Крайне важной задачей считается проведение оценки пригодности трансплантата поджелудочной железы. Необходимо учитывать большой спектр донорских показателей, использование интегральных индексов может несколько упростить и систематизировать процесс оценки. Не менее зна-чимым для результатов считается проведение адекватной противоишемической защиты панкреатодуо-денального комплекса. Несмотря на постоянный прогресс в развитии различных методик консервации, холодовая перфузия с использованием раствора Университета Висконсин (UW) остается «золотым стан-дартом». Эволюция хирургической техники трансплантации привела к наиболее физиологичным вари-антам дренирования экзокринного секрета и венозного оттока поджелудочной железы, которые призваны улучшить отдаленные метаболические эффекты и снизить частоту осложнений.Ключевые слова : трансплантация, почка, поджелудочная железа, иммуносупрессия, консервация, ишемия реперфузия, хирургическая техника.

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Enteric conversion after pancreatic transplantation: resolution of symptoms and long‐term results

Abstract: For the treatment of symptoms associated with BD, EC results in excellent long-term graft function and significant resolution of symptoms even years after SPK. Postoperative morbidity after EC including early reoperation and graft loss, however, has to be considered.

Cited by 22 publications

References 40 publications

Exocrine drainage in vascularized pancreas transplantation in the new millennium

Exocrine drainage in vascularized pancreas transplantation in the new millennium

Simultaneous pancreas-kidney transplantation: lessons learned from the initial experience of a single center in Korea

Pancreas transplantation in the treatment of diabetes mellitus type 1: modern aspects

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