Evolution of kidney, pancreas, and islet transplantation for patients with diabetes at the University of Minnesota

Sutherland, David E.R.; Gores, P. F.; Farney, Alan C.; Wahoff, David C.; Matas, Arthur J.; Dünn, David L.; Gruessner, Rainer W.G.; Najarían, John S.

doi:10.1016/s0002-9610(05)81142-0

Cited by 119 publications

(78 citation statements)

References 145 publications

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“…Consequently, optimal management of the pancreatic ductal secretions was identified as a controversy very early in the development of pancreas transplantation. In the late 1970s and early 1908s, partial or segmental pancreatic grafts (based on the body and tail of the pancreas) with pancreatic ductal ligation or occlusion were the preferred methods of controlling the pancreatic secretions [8,9] . During this developmental phase, exocrine drainage techniques were considered to be the "Achilles' heel" of pancreas transplantation.…”

Section: Introductionmentioning

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: Introductionmentioning

confidence: 99%

Exocrine drainage in vascularized pancreas transplantation in the new millennium

El‐Hennawy¹,

Stratta²,

Smith³

2016

WJT

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show abstract

“…There are various therapies to combat diabetes complications like Immunosuppression, Immunologic vaccination, Pancreatic transplantation. Replacement of patient"s Islet of langerhans either by pancreas transplantation or by isolated islet transplantation is the only treatment of diabetes mellitus that achieves insulin dependent, constant normoglycaemic state and avoidance of hypoglycaemic episodes [7]. Despite significant progress made, whole pancreas transplantation is still associated with preoperative mortality and significant morbidity [8].…”

Section: Type 1 Diabetes 211 Immunotherapymentioning

confidence: 99%

Diabetes and its management

Seherawat¹

2014

IOSRJESTFT

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“…Under the best of conditions, pancreas transplantation is plagued by a 10% incidence of technical complications, related in part to the need to divert the exocrine secretions (3). Added are the complications of immunosuppressive therapy and the limited availability of human pancreas donors.…”

Section: Islet Xenotransplantation: How Sweet It Is Editorialmentioning

confidence: 99%

Islet xenotransplantation: how sweet it is.

Platt¹

1996

J. Clin. Invest.

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Evolution of kidney, pancreas, and islet transplantation for patients with diabetes at the University of Minnesota

Cited by 119 publications

References 145 publications

Exocrine drainage in vascularized pancreas transplantation in the new millennium

Exocrine drainage in vascularized pancreas transplantation in the new millennium

Diabetes and its management

Islet xenotransplantation: how sweet it is.

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