Pancreas transplantation: The Wake Forest experience in the new millennium

Rogers, Jeffrey; Farney, Alan C.; Orlando, Giuseppe; Iskandar, Samy S.; Doares, William; Gautreaux, Michael D.; Kaczmorski, Scott; Reeves‐Daniel, Amber; Palanisamy, A.; Stratta, Robert J.

doi:10.4239/wjd.v5.i6.951

Cited by 20 publications

(56 citation statements)

References 28 publications

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“…However, in most cases, "portal venous" drainage usually infers that the allograft has a vertical orientation with the body and tail directed towards the pelvis, the head and duodenum directed cephalad, and the recipient SMV as the site for the venous anastomosis [18][19][20][21][22] (Figure 4). The bowel anastomosis is most commonly performed to a bowel loop that is not excluded from the transit of intestinal contents [4,16,17,33,[39][40][41][42][44][45][46][49][50][51][52][53][112][113][114][115][116][117][118][119][120][121] . Alternatively, the allograft duodenum can be connected directly into the native stomach or duodenum, to a diverting Roux limb without or with a venting jejunostomy, or to an omega loop [23][24][25][26][27][28][29][30][31][32]122] (Table 7).…”

Section: Bowel Drainage Of the Pancreatic Ductal Secretions (Portal-ementioning

confidence: 99%

“…The number of annual pancreas transplants reported to the Eurotransplant Network has similarly declined in the past decade whereas annual activity in the United Kingdom has remained relatively stable and activity elsewhere in the world has increased [1][2][3] . In spite of declining numbers, outcomes have continued to improve and include higher risk groups such as African-Americans, patients with a phenotype suggesting "type 2 diabetes" and solitary pancreas transplant recipients [1][2][3][4][5] . Five year patient survival rates are now nearly 90% across all three transplant types and 10-year patient survival is > 70% in all three groups.…”

Section: Introductionmentioning

confidence: 99%

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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: Bowel Drainage Of the Pancreatic Ductal Secretions (Portal-ementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Exocrine drainage in vascularized pancreas transplantation in the new millennium

El‐Hennawy¹,

Stratta²,

Smith³

2016

WJT

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“…59 In subsequent studies from this and other groups, C4d interacinar capillary staining was found in 20% to 60% of allograft biopsies. 54,55,[60][61][62][63] In a small study, one group documented reduced graft survival in the setting of both diffuse C4d staining and positive donor-specific antibodies. 61 Current Diagnostic Criteria for Pancreas ABMR.-The revised Banff classification of pancreas allograft rejection enumerates guidelines for diagnosis of acute ABMR.…”

Section: 51mentioning

confidence: 99%

“…52,53,55 Recently, classification schema for pancreas ABMR and cellular rejection were published under the auspices of the Banff group, based on contemporary data.…”

Section: Pancreasmentioning

confidence: 99%

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Practical Applications in Immunohistochemistry: Evaluation of Rejection and Infection in Organ Transplantation

Troxell¹,

Lanciault

2016

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Immunohistochemical analysis of tissue biopsy specimens is a crucial tool in diagnosis of both rejection and infection in patients with solid organ transplants. In the past 15 years, the concept of antibody-mediated rejection has been refined, and diagnostic criteria have been codified in renal, heart, pancreas, and lung allografts (with studies ongoing in liver, small intestine, and composite grafts), all of which include immunoanalysis for the complement split product C4d.Objectives.-To review the general concepts of C4d biology and immunoanalysis, followed by organ-allograftspecific data, and interpretative nuances for kidney, pancreas, and heart, with discussion of early literature for lung and liver biopsies. Additionally, practical applications and limitations of immunostains for infectious organisms (Polyomavirus, Adenoviridae [adenovirus], and the herpes virus family, including Herpes simplex virus, Cytomegalovirus, Human herpes virus 8, and Epstein-Barr virus) are reviewed in the context of transplant recipients.Data Sources.-Our experience and published primary and review literature.Conclusions.-Immunohistochemistry continues to have an important role in transplant pathology, most notably C4d staining in assessment of antibody-mediated rejection and assessment of viral pathogens in tissue. In all facets of transplant pathology, correlation of morphology with special studies and clinical data is critical, as is close communication with the transplant team.

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Surgical Technique of Pancreas Transplantation

Khan¹,

Smith²,

Rogers³

2019

Organ and Tissue Transplantation

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Pancreas transplantation: The Wake Forest experience in the new millennium

Abstract: In the new millennium, acceptable medium-term outcomes can be achieved in SKPT and SPTs as nearly 2/3rds of patients are insulin independent following pancreas transplantation.

Cited by 20 publications

References 28 publications

Exocrine drainage in vascularized pancreas transplantation in the new millennium

Exocrine drainage in vascularized pancreas transplantation in the new millennium

Practical Applications in Immunohistochemistry: Evaluation of Rejection and Infection in Organ Transplantation

Surgical Technique of Pancreas Transplantation

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