Pankreasorganentnahme durch externe Teams

Abstract

Combined pancreas and kidney transplantation is an established procedure for terminal or preterminal, uremic, type 1 diabetics. The current procurement technique allows simultaneous recovery of liver and pancreas. One problem is the assessment of organ quality. It remains unclear how many pancreas organs must be withdrawn during back-table preparation. Between June 1994 and December 2003, 271 pancreas transplantations were performed at our transplant centre. Two hundred sixty-two (89.7%) pancreas grafts were harvested by teams which were not part of the transplant team. Twenty-one (8.0%) grafts were discharged for transplantation at the time of back-table preparation. Liposis of the graft and critical vessel situations were the main reasons for withdrawal. Two kidney grafts were not usable for transplantation, and 92% of the pancreas grafts were. This demonstrates the high standard of pancreas procurement in the Eurotransplant region.

Influence of donor- and recipient-specific factors on the postoperative course after combined pancreas–kidney transplantation

“…Our findings prove, at least for early outcome after transplantation, that the surgical team carrying out the procurement do not influence the prevalence of complications. This supports the fact that it is acceptable that a local procurement team does the procedure, in contrast to, for example, heart and lung transplantation where the transplanting center does the procurement [19]. The quality of perfusion had no influence on the prevalence of complications.…”

“…The mean age of donors was 34.1 years (range, 11-58 years). Based on a recent publication [11], the donors had a mean "preprocurement pancreas allocation suitability score (P-PASS) of 14 (range, [9][10][11][12][13][14][15][16][17][18][19]. The mean length of stay of the recipient in hospital starting with the transplantation and ending with the first discharge was 55 days (range, 21-219 days).…”

Kombinierte Nieren-Pankreas-Transplantation

“…In unserem Kollektiv konnte dies nicht bestätigt werden. Möglicherweise liegt dies an der heute in vielen Zentren nur geringen Rate transplantierter Organe mit kritisch langer Ischämiezeit [4,18,24].…”

“…Zudem scheint es zu einer Verbesserung der diabetischen Folgeerkrankungen und der Lebensqualität zu kommen [1, 23].Gegenwärtig beträgt die 5-Jahres-Pankreastransplantatfunktionsrate 72-85%, die 5-Jahres-Patientenüberlebensrate liegt bei 78-94% [6,18]. Zu den Einflussfaktoren, die einen günstigen Effekt auf die Transplantatfunktion nach simultaner NierenPankreas-Transplantation ausüben kön-nen, gehören ein junges Spenderalter, eine kurze kalte Ischämiezeit, die Anwendung moderner immunsuppressiver Medikamente sowie die Übereinstimmung verschiedener HLA-Moleküle zwischen Spender und Empfänger [6,11,15].…”