Improved Survival in Patients With Insulin-Dependent Diabetes Mellitus and End-Stage Diabetic Nephropathy 10 Years After Combined Pancreas and Kidney Transplantation1

Tydén, G; Bolinder, Jan; Solders, Göran; Brattström, C; Tibell, Annika; Groth, C. G.

doi:10.1097/00007890-199903150-00001

Cited by 226 publications

(114 citation statements)

References 14 publications

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“…The ultimate goal of pancreas transplantation as a treatment option for type I diabetes is freedom from exogenous insulin administration with improvement or disappearance of diabetic secondary complications and improved quality of life (18)(19)(20)(21)(22)(23). That pancreas transplantation has achieved widespread acceptance as a safe and effective treatment for type I diabetes is reflected in the much improved results reported over the last several years, which has been facilitated in our center by the use ofTAC as a primary therapy for immunosuppression without antilymphocyte induction therapy (3,5,24).…”

Section: Discussionmentioning

confidence: 99%

Results of Pancreas Transplantation After Steroid Withdrawal Under Tacrolimus Immunosuppression 1

et al. 2000

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Purpose-The results of steroid withdrawal in pancreas transplant recipients under tacrolimus immunosuppression were analyzed. July 4, 1994 until April 30, 1998, 147 pancreas transplantations were performed in 141 patients, including 126 simultaneous pancreas-kidney transplantations, 13 pancreas after kidney transplantation, and 8 pancreas transplantations alone. Baseline immunosuppression consisted of tacrolimus and steroids without antilymphocyte induction. Twenty-three patients were excluded from analysis because of early graft loss in 17 cases, retransplantation in 5 cases, and simultaneous pancreas-kidney transplantation after heart transplantation in 1 patient. Methods-FromResults-With a mean follow-up of 2.8±1.1 years (range 1.0 to 4.8 years), complete steroid withdrawal was achieved in 58 (47%) patients with a mean time to steroid withdrawal of 15.2±8 months (range 4 to 40 months after transplantation). Of the entire cohort of 141 patients, overall 1-, 2-, and 4-year patient survival rates were 98%, 95.5%, and 86%, respectively. Overall 1-, 2-, and 4-year graft survival rates were 83%, 80%, and 71% (pancreas) and 95%, 91%, and 84% (kidney), respectively. Of the 124 patients analyzed for steroid withdrawal, 1-, 2-, and 4-year patient survival rates were 98%, 97%, and 92%, respectively. Overall 1-, 2-, and 4-year graft survival rates were 98%, 91.5%, 83% (pancreas) and 97%, 95%, and 91% (kidney). Patient, pancreas, and kidney survival rates at 1 year were 100%, 100%, and 98% (off steroids) versus 97%, 91%, and 96% (on steroids, all NS) and at 4 years were 100%, 94%, and 95% (off steroids) versus 78%, 68%, and 85% (on steroids, P=0.01, 0.002, and NS, respectively). The cumulative risk of rejection at the time of follow-up was 76% for patients on steroids versus 74% for patients off steroids (P=NS). Seven patients originally tapered off steroids were treated for subsequent rejection episodes, which were all steroid sensitive, and two of these seven patients are currently off steroids. Thirteen patients received antilymphocyte therapy for steroid-resistant rejection, five of whom are now off steroids. Tacrolimus trough levels were 9.3±2.4 ng/ml (off steroids) and 9.7±4.3 (on steroids, P=NS). Mean fasting glucose levels were 98±34 mg/dl (off steroids) and 110±41 mg/dl (on steroids, P=NS). Mean glycosylated hemoglobin levels were 5.2±0.9% (off steroids) and 6.2±2.1% (on steroids, P=0.02), and mean serum creatinine levels were 1.4±0.8 mg/dl (off steroids) and 1.7±1.0 mg/dl (on steroids, P=0.02). Conclusion-These data show for the first time that steroid withdrawal can be safely accomplished in pancreas transplant recipients maintained on tacrolimus-based immunosuppression. Steroid withdrawal is associated with excellent patient and graft survival with no increase in the cumulative risk of rejection.The results of pancreas transplantation have improved dramatically over the last decade with 1-year patient survival rates greater than 90%, and pancreas graft survival rates in simultaneous pancreas-kidney tra...

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Section: Discussionmentioning

confidence: 99%

Results of Pancreas Transplantation After Steroid Withdrawal Under Tacrolimus Immunosuppression 1

et al. 2000

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“…Thus, it seems likely that the mortality rates a re related more to chronic diabetes than to p a n c reas transplantation itself. Initial conc e rns that mortality after SPK is gre a t e r than that after kidney transplantation alone (44) have not been substantiated in subsequent studies (3,45).…”

Section: Risks and Cost-benefit Analysesmentioning

confidence: 99%

Pancreas and islet transplantation for patients with diabetes.

et al. 2000

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“…These patients will invariably develop chronic renal failure after some years and the ideal treatment for them is SPK transplantation. Since these patients will require immunosuppression for kidney transplant, combining a pancreas transplant along with kidney only adds to the surgical risk but significantly improves the quality of life and the long-term outcomes when compared to the kidney transplant alone [11].…”

Section: Discussionmentioning

confidence: 99%

Management of Graft Duodenal Leak in Simultaneous Pancreas Kidney Transplant—a Case Report from India and Review of Literature

et al. 2016

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Pancreatic transplantation is currently the only effective cure for Type 1 diabetes mellitus. It allows long-term glycemic control without exogenous insulin and amelioration of secondary diabetic complications. In India, pancreas transplant has not yet established with only a single successful transplant reported so far in the literature. We report a 24-year-old Type 1 diabetic patient with renal failure who underwent a simultaneous pancreas kidney transplant. On postoperative day 15, he had leak from the graft duodenal stump for which a tube duodenostomy and proximal diversion enterostomy was done. He had a high output pancreatic fistula following the procedure which was managed conservatively. The tube duodenostomy was removed at three and half months and enterostomy closure with restoration of bowel continuity was done at 6 months. After a follow up of 7 months, patient is doing well with a serum creatinine of 0.8 mg/dl and normal blood sugars, not requiring any exogenous insulin or oral hypoglycemic drugs. Managing patients with graft duodenal complications after pancreas transplant is challenging. Tube duodenostomy is a safe option in management of duodenal leak, although can lead to a persistent pancreatic fistula. A proximal diversion enterostomy allows early oral feeding and avoids the cost as well as the long term complications associated with parenteral nutrition.

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Improved Survival in Patients With Insulin-Dependent Diabetes Mellitus and End-Stage Diabetic Nephropathy 10 Years After Combined Pancreas and Kidney Transplantation1

Cited by 226 publications

References 14 publications

Results of Pancreas Transplantation After Steroid Withdrawal Under Tacrolimus Immunosuppression 1

Results of Pancreas Transplantation After Steroid Withdrawal Under Tacrolimus Immunosuppression 1

Pancreas and islet transplantation for patients with diabetes.

Management of Graft Duodenal Leak in Simultaneous Pancreas Kidney Transplant—a Case Report from India and Review of Literature

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