Solitary pancreas transplantation: a review of the <scp>UK</scp> experience over a period of 10 yr

Vrakas, G.; Arantes, Rubens Macedo; Gerlach, Undine; Reddy, Srikanth; Friend, Peter J.; Vaidya, Anil

doi:10.1111/ctr.12650

Cited by 22 publications

(18 citation statements)

References 19 publications

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“…28 In the past, the PAK approach had a higher rate of early pancreas graft losses, often for technical reasons, and a lower long term pancreas graft survival rate than the SPK combination. 31 However, over the past decade, the greatest improvements in outcome have been made in the PAK category and the results of PAK no longer trail those of SPK. 20 The appropriate treatment option for transplant candidates with diabetes and chronic kidney disease depends on several factors, including the availability of a suitable living kidney donor, renal function at the time of referral to a transplant center, and expected waiting time for an SPK.…”

Section: Long Term Benefitsmentioning

confidence: 99%

Pancreas transplantation

Dean

Kukla

Stegall

et al. 2017

BMJ

120

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The treatment of patients with diabetes mellitus (DM) presents many challenges to care providers and represents a major proportion of healthcare expenditure worldwide. Successful pancreas transplantation provides durable glycemic control and improves survival for patients with diabetes. Progress in the field has mainly been based on large single center studies and the cumulative analyses of registry data from the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry. This review focuses on the outcomes of pancreas transplantation for patients with and without end stage renal disease. It describes the current state of pancreas transplantation, gaps in knowledge, and future studies needed to enable more patients to benefit from this treatment. A common theme that emerges is the need for multicenter randomized trials in pancreas transplantation to define clearly the efficacy, risks, and long term benefits.

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Section: Long Term Benefitsmentioning

confidence: 99%

Pancreas transplantation

Dean

Kukla

Stegall

et al. 2017

BMJ

120

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“…The prevalence of unexpected APR in grafts removed for duodenal leaks and peripancreatic collections may reflect the non‐depleting antibody induction regimen used in our unit. There is some evidence to suggest that depleting induction regimens lead to a lower rate of APR at three months but no clear evidence to suggest that they reduce graft loss . Of note, Al‐Adra et al also found APR in grafts explanted for duodenal leak, despite the use of depleting agents at induction .…”

Section: Discussionmentioning

confidence: 99%

Early allograft pancreatectomy—Technical failure or acute pancreatic rejection?

Wallace

Bunnett

Fryer

et al. 2019

Clinical Transplantation

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Introduction “Technical failure” is still perceived to be a frequent cause of graft loss after pancreas transplantation. However, some early graft losses currently attributed to technical failure could be due to unrecognized acute pancreas rejection (APR). Methods We investigated the apparent incidence of APR in cases of early allograft pancreatectomy (EAP) that had previously been attributed to technical failure. We performed an analysis of 198 patients who underwent pancreas transplantation between January 2009 and January 2016 and identified all those with EAP within 90 days of transplantation. Explanted grafts of EAP recipients were re‐examined histologically to evaluate for evidence of APR using current Banff criteria. Results Twenty‐three EAPs were identified (11.6%; 23/198). APR was identified histologically in 9 out of the 15 recipients who lost their grafts due to duodenal leaks or recurrent peripancreatic collections, but was not identified in any of the patients whose grafts were lost due to thrombosis or ischemia. Interpretation Unsuspected APR appears common in the explanted grafts of recipients who have undergone EAP for apparently “technical” reasons. We suggest that EAP should be defined as a technical failure only when APR of the pancreas (or duodenum) has been excluded by histological analysis.

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“…The main causes of these complications and graft failure pointed by different authors are: surgical damage to the graft during procurement and vascular events mainly thrombosis [24,25]. Both may be related to the donor condition.…”

Section: Introductionmentioning

confidence: 99%

“…During the last decade, attention was paid to the influence of the donor's age, BMI, alcohol use and other factors [25].…”

Section: Introductionmentioning

confidence: 99%

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Untitled

2018

BIOMEDJ

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Background In spite of progresses in harvesting techniques, pancreatic graft early failure remains frequent probably due to pancreas microcirculatory system fragility. Present work aim: investigation of the donor's death cause influence on the pancreas graft. Methods A first part was devoted to the morphological investigation of 113 pancreases from <24 hours dead persons divided into groups according to age (8-92 years) and death causes. The pancreas blood vessels were injected with protacryl and submitted to corrosion. Morphometry and histologic examination of the vessels were performed.

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Solitary pancreas transplantation: a review of the UK experience over a period of 10 yr

Cited by 22 publications

References 19 publications

Pancreas transplantation

Pancreas transplantation

Early allograft pancreatectomy—Technical failure or acute pancreatic rejection?

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