Pancreas transplantation

White, Steve; Shaw, James; Sutherland, David E.R.

doi:10.1016/s0140-6736(09)60609-7

Cited by 309 publications

(292 citation statements)

References 117 publications

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“…However, thereafter it reverses with transplanted patients performing better at 1 year. 5 The EUROSPK study 6 reported a much higher 44.8% rejection rate than that in our study (11.8%), but we continued steroids for Ն6 months after transplantation, which may in part explain the difference. Four of our patients lost their grafts due to rejection: 1 pancreas and kidney loss, 2 kidney losses, and 1 sole pancreas loss.…”

Section: Discussioncontrasting

confidence: 56%

“…1 Two important recently published papers have concluded that SPKT provides a significant extension to patient life, 1 namely 10 years longer than that of KTA from a deceased donors. 5 Our perception is that SPKT patients are really difficult to manage not only in the early period, but also in follow-up. Complications are frequent; costs are high and directly related to the complication rate.…”

Section: Discussionmentioning

confidence: 99%

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Pancreas-Kidney Transplantation: Complications and Readmissions in 9-Years of Follow-up

Martins

Henriques

Dias

et al. 2010

Transplantation Proceedings

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Over 9 years, we have performed 93 simultaneous pancreas-kidney transplants (SPKT). The morbidity of this procedure is high compared with kidney transplantation alone; readmissions are frequent and costs are higher. Herein we have presented the complications during follow-up of these 93 patients. Their mean age was 34 Ϯ 6 years and prior dialysis time was 32 Ϯ 25 months. The median hospital stay on the first admission for the transplant procedure was 22 days, including 2 days in the intensive care unit. Bleeding, thrombosis, and infection were the most frequent reasons for prolonged hospitalization. Thirty patients underwent Ն1 surgical reinterventions. Incidence of acute rejection episodes was 11.8%. After discharge, 74.2% of the patients had 197 readmission episodes with infection being the main cause, urinary tract infections, the most frequent; however, systemic viral and fungal infections required the longest readmission periods. The need for surgical interventions, graft dysfunction, and vascular problems were the remaining causes of readmission. At the end of follow-up, 87 patients were alive, 86 with well-functioning kidneys and 74 with normal functioning pancreata. Global survival rates for patient, kidney, and pancreas were 96%, 95%, and 81% at 1-year; 93%, 90%, and 79% at 5-years; and 93%, 90% and 79% at 9-years. Although pancreas-kidney transplant patients are complex presenting many management difficulties, our overall results represent a positive stimulus for diabetic patients. S imultaneous pancreas-kidney transplantation (SPKT)display greater morbidity, length of admission, and number of complications when compared to kidney transplantation alone (KTA), leading to higher costs. However, SPKT remains the best treatment option for good longterm results among type 1 diabetic patients with chronic kidney failure. A recently published review of 1000 SPKT from a single center 1 reinforced this position statement of the American Diabetes Association. We have presented herein the results of our SPKT program, including the rate and type of complications, causes of surgical reinterventions, and readmission episodes after the initial discharge. PATIENTS AND METHODSFrom May 2000 to May 2009, we performed 93 SPKT always using enteric diversion and vascular anastomoses to the systemic circulation. Immunosuppression included antithymocyte globulin (ATG) tacrolimus, mycophenolate mofetil (MMF), and steroids. After the 6th month, it was our policy to progressively taper steroids to complete withdrawal whenever possible. Infection prophylaxis comprised vancomycin, fluconazole, and a third-generation cephalosporin in the first days, with contrimoxazole and valgancyclovir thereafter. We also prescribed aspirin and low-molecularweight heparin as soon as possible after surgery, if there were no bleeding complications. RESULTSThe mean age of the 93 patients was 34 Ϯ 6 years with a 23 Ϯ 5.5 years, duration of diabetes. They had been on dialysis for 32 Ϯ 25 months excepting 4 who were grafted preemptively. Twenty...

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Pancreas-Kidney Transplantation: Complications and Readmissions in 9-Years of Follow-up

Martins

Henriques

Dias

et al. 2010

Transplantation Proceedings

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“…Simultaneous pancreas–kidney (SPK) transplantation restores insulin secretion and renal function in T1D patients with end‐stage renal disease (ESRD) 8. However, recipients may develop posttransplant diabetes, a broad clinical entity with multifactorial etiology including effects of immunosuppression, insulin resistance, weight gain, and others 9, 10.…”

Section: Introductionmentioning

confidence: 99%

“…However, recipients may develop posttransplant diabetes, a broad clinical entity with multifactorial etiology including effects of immunosuppression, insulin resistance, weight gain, and others 9, 10. With advances in immunosuppression, acute rejection has become less prevalent and immunological failures are typically ascribed to chronic rejection 8. However, another potential cause of immunological failure is T1D recurrence 11, 12.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Type 1 Diabetes Recurrence in Immunosuppressed Recipients of Simultaneous Pancreas–Kidney Transplants

Vendrame

Hopfner

Diamantopoulos

et al. 2016

American Journal of Transplantation

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Patients with type 1 diabetes (T1D) who are recipients of pancreas transplants are believed to rarely develop T1D recurrence in the allograft if effectively immunosuppressed. We evaluated a cohort of 223 recipients of simultaneous pancreas–kidney allografts for T1D recurrence and its risk factors. With long‐term follow‐up, recurrence was observed in approximately 7% of patients. Comparing the therapeutic regimens employed in this cohort over time, lack of induction therapy was associated with recurrence, but this occurs even with the current regimen, which includes induction; there was no influence of maintenance regimens. Longitudinal testing for T1D‐associated autoantibodies identified autoantibody positivity, number of autoantibodies, and autoantibody conversion after transplantation as critical risk factors. Autoantibodies to the zinc transporter 8 had the strongest and closest temporal association with recurrence, which was not explained by genetically encoded amino acid sequence donor–recipient mismatches for this autoantigen. Genetic risk factors included the presence of the T1D‐predisposing HLA‐DR3/DR4 genotype in the recipient and donor–recipient sharing of HLA‐DR alleles, especially HLA‐DR3. Thus, T1D recurrence is not uncommon and is developing in patients treated with current immunosuppression. The risk factors identified in this study can be assessed in the transplant clinic to identify recurrent T1D and may lead to therapeutic advances.

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“…En concordancia con resultados obtenidos en grandes centros [12][13][14] , en esta experiencia la sobrevida de pacientes fue de 70%, la sobrevida de páncreas 72% y la sobrevida de riñón fue de 73% en 10 años cifras superiores a la sobrevida de diabéticos en diálisis en lista de espera de trasplante, que es 46% a cuatro años 15 . Al fi nal del período de observación 9 pacientes estaban euglicémicos en ayunas, presentaban niveles normales de Péptido C e independencia de insulina o hipoglicemiantes orales, independencia de diálisis en 8 pacientes.…”

Section: Discussionunclassified

Trasplante simultáneo de páncreas y riñon en diabetes mellitus tipo 1: Experiencia de un centro en Chile

et al. 2011

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Pancreas transplantation

Cited by 309 publications

References 117 publications

Pancreas-Kidney Transplantation: Complications and Readmissions in 9-Years of Follow-up

Pancreas-Kidney Transplantation: Complications and Readmissions in 9-Years of Follow-up

Risk Factors for Type 1 Diabetes Recurrence in Immunosuppressed Recipients of Simultaneous Pancreas–Kidney Transplants

Trasplante simultáneo de páncreas y riñon en diabetes mellitus tipo 1: Experiencia de un centro en Chile

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