Solitary Pancreas Transplantation: Experience with 62 consecutive cases

Stratta, Robert J.; Weide, Lamont G.; Sindhi, Rakesh; Sudan, Debra; Jerius, John T.; Larsen, Jennifer L.; Cushing, Kathleen; Grune, Martin T.; Radio, Stanley J.

doi:10.2337/diacare.20.3.362

Cited by 26 publications

(14 citation statements)

References 18 publications

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“…A few other programs have increased the proportion of solitary pancreas transplants in recent years, 188,193 with results equivalent to our own. 38 Although a few aspects of our program are original, much of what we have done has been adapted from the pioneering efforts of others.…”

Section: Discussionmentioning

confidence: 71%

Lessons Learned From More Than 1,000 Pancreas Transplants at a Single Institution

Sutherland¹,

Gruessner²,

Dünn³

et al. 2001

Annals of Surgery

616

434

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ObjectiveTo determine outcome in diabetic pancreas transplant recipients according to risk factors and the surgical techniques and immunosuppressive protocols that evolved during a 33-year period at a single institution. Summary Background DataInsulin-dependent diabetes mellitus is associated with a high incidence of management problems and secondary complications. Clinical pancreas transplantation began at the University of Minnesota in 1966, initially with a high failure rate, but outcome improved in parallel with other organ transplants. The authors retrospectively analyzed the factors associated with the increased success rate of pancreas transplants. MethodsFrom December 16, 1966, to March 31, 2000, the authors performed 1,194 pancreas transplants (111 from living donors; 191 retransplants): 498 simultaneous pancreas-kidney (SPK) and 1 simultaneous pancreas-liver transplant; 404 pancreas after kidney (PAK) transplants; and 291 pancreas transplants alone (PTA). The analyses were divided into five eras: era 0, 1966 to 1973 (n ϭ 14), historical; era 1, 1978 to 1986 (n ϭ 148), transition to cyclosporine for immunosuppression, multiple duct management techniques, and only solitary (PAK and PTA) transplants; era 2, 1986 to 1994 (n ϭ 461), all categories (SPK, PAK, and PTA), predominately bladder drainage for graft duct management, and primarily triple therapy (cyclosporine, azathioprine, and prednisone) for maintenance immunosuppression; era 3, 1994 to 1998 (n ϭ 286), tacrolimus and mycophenolate mofetil used; and era 4, 1998 to 2000 (n ϭ 275), use of daclizumab for induction immunosuppression, primarily enteric drainage for SPK transplants, pretransplant immunosuppression in candidates awaiting PTA. ResultsPatient and primary cadaver pancreas graft functional (insulinindependence) survival rates at 1 year by category and era were as follows: SPK, era 2 (n ϭ 214) versus eras 3 and 4 combined (n ϭ 212), 85% and 64% versus 92% and 79%, respectively; PAK, era 1 (n ϭ 36) versus 2 (n ϭ 61) versus 3 (n ϭ 84) versus 4 (n ϭ 92), 86% and 17%, 98% and 59%, 98% and 76%, and 98% and 81%, respectively; in PTA, era 1 (n ϭ 36) versus 2 (n ϭ 72) versus 3 (n ϭ 30) versus 4 (n ϭ 40), 77% and 31%, 99% and 50%, 90% and 67%, and 100% and 88%, respectively. In eras 3 and 4 combined for primary cadaver SPK transplants, pancreas graft survival rates were significantly higher with bladder drainage (n ϭ 136) than enteric drainage (n ϭ 70), 82% versus 74% at 1 year (P ϭ .03). Increasing recipient age had an adverse effect on outcome only in SPK recipients. Vascular disease was common (in eras 3 and 4, 27% of SPK recipients had a pretransplant myocardial infarction and 40% had a coronary artery bypass); those with no vascular disease had significantly higher patient and graft survival rates in the SPK and PAK categories. Living donor segmental pancreas transplants were associated with higher technically successful graft survival rates in each era, predominately solitary (PAK and PTA) in eras 1 and 2 and SPK in eras 3 and 4. Diabetic seconda...

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Section: Discussionmentioning

confidence: 71%

Lessons Learned From More Than 1,000 Pancreas Transplants at a Single Institution

Sutherland¹,

Gruessner²,

Dünn³

et al. 2001

Annals of Surgery

616

434

View full text Add to dashboard Cite

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“…The indication for PTA was established after assessment of benefits and risks for each patient. In line with recommendations from other studies [18][19][20], in our centre we consider PTA for patients who have two or more overt diabetic complications and/or glucose hyperlability with hypoglycaemic unawareness and impaired quality of life. Contraindications include: age >60 years, active smoking, obesity (BMI >30 kg/m 2 ), left ventricular ejection fraction <40%, active malignancy or infection, and unstable psychological profile.…”

Section: Patients' Clinical Datamentioning

confidence: 80%

Pancreas transplant alone has beneficial effects on retinopathy in type 1 diabetic patients

et al. 2006

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Aims/hypothesis The effects of successful pancreas transplant alone (PTA) on chronic complications of diabetes, in particular diabetic retinopathy, remain disputed. We prospectively studied the course of diabetic retinopathy in PTA recipients and in non-transplanted (non-PTA) type 1 diabetic patients. Methods The PTA and non-PTA groups consisted respectively of 33 (follow-up: 30±11 months) and 35 patients (follow-up: 28±10 months). Best corrected visual acuity, slit lamp examination, intraocular pressure measurement, ophthalmoscopy, retinal photographs, and in selected cases angiography were performed. Diabetic retinopathy and its improvement/deterioration were assessed according to criteria proposed by the Eurodiab Study. Results At baseline, 9% of PTA and 6% of non-PTA patients had no diabetic retinopathy, 24 and 29% had non-proliferative diabetic retinopathy (NPDR), whereas 67 and 66% had laser-treated and/or proliferative diabetic retinopathy (LT/ PDR), respectively. No new case of diabetic retinopathy occurred in either group during follow-up. In the NPDR PTA group, 50% of patients improved by one grading, and 50% showed no change. In the LT/PDR PTA, stabilisation was observed in 86% of cases, whereas worsening of retinopathy occurred in 14% of patients. In the NPDR non-PTA group, diabetic retinopathy improved in 20% of patients, remained unchanged in 10%, and worsened in the remaining 70%. In the LT/PDR non-PTA group, retinopathy did not change in 43% and deteriorated in 57% of patients. Overall, the percentage of patients with improved or stabilised diabetic retinopathy was significantly higher in the PTA group. No differences were found between the two groups with regard to cataract lesions and intraocular pressure values. Conclusions/interpretation Despite a relatively short follow-up, our study shows that successful PTA can positively affect the course of diabetic retinopathy.

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“…In particular, 10 patients (33%) in the nontransplanted group and 17 patients (53%) in the group of patients who then received pancreas transplant alone were on ACE inhibitors. Indications for solitary pancreas transplantation (12)(13)(14) were the presence of two or more overt diabetes complications (23 patients, 72%) and/or glucose hyperlability with hypoglycemic unawareness and impaired quality of life (9 patients, 28%). The number of patients in the nontransplanted group with these two conditions were 21 (70%) and 9 (30%), respectively.…”

Section: Research Design Andmentioning

confidence: 99%

The Beneficial Effects of Pancreas Transplant Alone on Diabetic Nephropathy

et al. 2005

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OBJECTIVE -Pancreas transplant alone can be effective in significantly improving the quality of life of type 1 diabetic patients, and it can also eliminate acute diabetes complications, such as hypoglycemic and/or hyperglycemic episodes. The effects of pancreas transplant alone on long-term complications of diabetes, including nephropathy, are still not settled. We evaluated whether restoration of long-lasting normoglycemia by pancreas transplant alone might have beneficial action on diabetic nephropathy. RESEARCH DESIGN AND METHODS-A total of 32 type 1 diabetic patients were evaluated before and 1 year after successful pancreas transplant alone, together with 30 matched nontransplanted type 1 diabetic subjects. Several metabolic and kidney function parameters were measured, including plasma glucose, glycohemoglobin (A1C), C-peptide, plasma lipids, blood pressure, creatinine, creatinine clearance, and urinary protein excretion.RESULTS -Pancreas transplant alone restored sustained normoglycemia, without exogenous insulin administration, and improved plasma lipid levels. Blood pressure decreased significantly. Creatinine concentrations and clearances did not differ before and after transplantation. Urinary protein excretion decreased significantly after pancreas transplant alone, with four microalbuminuric and three macroalbuminuric patients who became normoalbuminuric. None of these changes occurred in the nontransplanted group.CONCLUSIONS -Successful pancreas transplant alone, through restoration of sustained normoglycemia, improves diabetic nephropathy in type 1 diabetic patients. Diabetes Care 28:1366 -1370, 2005D iabetic nephropathy is the most common single cause of end-stage renal disease in the U.S. and Europe (1). In the U.S., this late diabetes complication accounts for ϳ40% of new cases of end-stage renal disease, with costs that exceed $15 billion per year (1). Epidemiological data show that ϳ20 -30% of patients with diabetes develop nephropathy (1-4). The earliest clinical sign of nephropathy is the appearance of low but abnormal levels (Ͼ30 mg/day or 20 g/ min) of albumin in the urine, referred to as microalbuminuria. Without specific interventions, 80% of subjects with type 1 diabetes who develop sustained microalbuminuria have their urinary albumin excretion increase at a rate of 10 -20% per year to the stage of overt nephropathy or clinical albuminuria (up to 300 mg/24 h or 200 g/min) over a period of 10 -15 years, with hypertension also developing along the way. Once overt nephropathy occurs, without specific treatment the glomerular filtration rate gradually falls over a period of several years at a rate that is highly variable from individual to individual (2-20 ml ⅐ min Ϫ1 ⅐ year Ϫ1 ). Eventually, end-stage renal disease develops in 50% of type 1 diabetic individuals with overt nephropathy within 10 years and in Ͼ75% by 20 years. In addition to its being the earliest manifestation of nephropathy, proteinuria is a marker of greatly increased cardiovascular morbidity and mortality for patients w...

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Solitary Pancreas Transplantation: Experience with 62 consecutive cases

Abstract: Despite morbidity, solitary pancreas transplantation can be performed with improving success, can enhance quality of life, and can offer an opportunity to arrest secondary diabetic complications.

Cited by 26 publications

References 18 publications

Lessons Learned From More Than 1,000 Pancreas Transplants at a Single Institution

Lessons Learned From More Than 1,000 Pancreas Transplants at a Single Institution

Pancreas transplant alone has beneficial effects on retinopathy in type 1 diabetic patients

The Beneficial Effects of Pancreas Transplant Alone on Diabetic Nephropathy

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