Renal autotransplantation

In the period, 1973-1985, a total of 305 renal autotransplantations (often with extracorporeal repair) were performed in 274 patients for fibromuscular (56) or atherosclerotic (98) renovascular disease, nephrolithiasis (97), renal tumor (15), or ureteral injury (8). One-third of the patients had reduced renal function, and approximately half of the patients with renovascular lesions presented with severe or malignant hypertension. The postoperative mortality rate of 4% was related to age over 60 years and reduced renal function. Postoperatively, 3.6% of the autografted kidneys were lost due to vascular thrombosis (7) or other causes (4). Twenty-five percent (69) of the patients had a solitary kidney. Two patients died postoperatively with functioning autografts. Long-term renal function remained stable in 60 patients, and deteriorated in 7. We conclude that autotransplantation and extracorporeal repair provide safe and efficient treatment for selected difficult renal lesions.

Long-term metabolic control in recipients of segmental-pancreas grafts with pancreaticoenterostomy or duct obstruction

Metabolic control in recipients of segmental-pancreas grafts with pancreaticoenterostomy (performed in Stockholm) or duct obstruction by polymer injection (performed in Oslo) were compared. The recipients were uremic diabetic patients and also received a kidney from the same donor. Because the patient population in the two Scandinavian countries is very similar and the immunosuppressive protocols used are almost identical, such a comparison seemed reasonable. The number of patients available for study at 1, 2, and 3 yr was 22, 10, and 4, respectively, with duct injection and 28, 10, and 3 with pancreaticoenterostomy. The mean age of the patients was somewhat higher in the Oslo series. There were no significant differences regarding immunosuppression or kidney-graft function as estimated by serum creatinine at 1, 2, and 3 yr. No significant differences were found in fasting blood glucose, glycosylated hemoglobin, and intravenous glucose tolerance between the two groups at 1, 2, and 3 yr.

Simultaneous transplantation of pancreas and kidney in patients with advanced diabetic complications

From June 1983 to October 1985, 25 uremic diabetic patients aged 24 to 52 (mean 38) years were treated with combined pancreas and kidney transplantation. Mean duration of diabetes was 24 years, and end-stage renal disease was associated with severe extrarenal diabetic complications in all recipients. All transplants were harvested from cadaveric, heart-beating donors aged 5-55 years. The segmental pancreas transplant was duct-occluded with neoprene before it was transplanted to the left iliac fossa. Immunosuppressive treatment was given with cyclosporine and steroids in all cases while azathioprine was added in the last 5 cases. The one year survival of patient, kidney and pancreas was 96, 79 and 60 per cent respectively. Of 17 patients with functioning pancreas transplants, 13 are insulin independent and have normal or near normal glucose homeostasis. Based on the excellent patient survival and the improvement in quality of life experienced by the recipients, it is concluded that simultaneous transplantation of pancreas and kidney should be the treatment of choice for uremic diabetic patients when a living related kidney donor is unavailable.

Insulin potentiates cholecystokinin (CCK)-induced secretion of pancreatic kallikrein

The effects of insulin on pancreatic kallikrein secretion were studied in streptozotocin diabetic rats and after acute administration of insulin to normal rats. Studies on total protein and amylase secretion were included for comparison. In diabetic rats, the concentration of amylase in pancreatic tissue as well as basal and CCK-stimulated amylase exocrine secretion were significantly reduced. Insulin treatment restored pancreatic tissue concentration and exocrine release of amylase to normal. Insulin deficiency did not induce any change in the concentration of kallikrein or trypsin-like activity in pancreatic tissue. However, basal kallikrein secretion was higher in diabetic rats than in controls. Insulin treatment of diabetics rats did not alter basal kallikrein secretion but potentiated CCK-stimulation of kallikrein release. In normal rats, CCK induced an increase of pancreatic protein, amylase, and kallikrein secretion but not pancreatic juice flow. Additional administration of insulin potentiated the CCK-induced secretory rate of pancreatic juice, protein, and kallikrein but not amylase. A 1.6 times higher concentration of kallikrein was found in the portal vein than in arterial blood, indicating an endocrine release of pancreatic kallikrein. No difference in the concentration of circulating kallikrein was observed between the control and the insulin-treated group.

Quantitative studies of glomerular ultrastructure in human and experimental diabetes

A brief review is given of glomerular structural changes in diabetes mellitus and in rats with induced diabetes. The stereological methods for obtaining quantitative structural data are mentioned, and references are given to the underlying theories as well as to more detailed descriptions of the practical performance. In short-term diabetes a glomerular hypertrophy is found with increase in the surface area of the capillaries, in parallel with an increase in glomerular filtration. In long-term diabetes mellitus the picture is dominated by accumulations of basement membrane: thickening of the peripheral basement membrane and expansion of the mesangial regions which hold large amounts of basement membrane material. Rats with a moderate diabetes show the early hypertrophy as well as long-term basement membrane thickening. Severely diabetic rats develop basement membrane thickening but do not show the early hypertrophy, which is therefore not a necessary condition for basement membrane thickening to occur.

Normalization of hepatic lysosomal autophagy in streptozotocin diabetic rats after pancreatic transplantation

This study was performed to determine whether the enhanced hepatic autophagocytosis occurring in diabetes mellitus could be reversed by pancreatic transplantation despite the persistence of hyperglucagonemia in transplant recipients. Twenty weeks after pancreatic transplantation, hepatic lysosomes and autophagic vacuoles were quantitated morphometrically in untreated streptozotocin-diabetic rats and in streptozotocin-diabetic rats treated by pancreatic transplantation. Hyperglycemia and hypoinsulinemia in untreated diabetic rats were corrected after pancreatic transplantation. However, the peripheral plasma glucagon concentration remained significantly higher in transplant recipients than in non-diabetic controls. Light microscopic morphometry revealed no significant effect of the diabetic state or its reversal on the volume of the single hepatocyte or the volume density and numerical density of hepatocytes. However, electron microscopic examination showed that the number and volume density of lysosomes and autophagic vacuoles, which were significantly increased in diabetic rats, returned to control values after pancreatic transplantation. It is concluded that chronic hyperglucagonemia does not preserve enhanced hepatic autophagocytosis when the diabetic hypoinsulinemia is corrected by the pancreatic transplant.

The duct-ligated pancreas transplant and its effect on the islet cellular composition of the host pancreas. A morphometric analysis

Rats rendered diabetic by streptozotocin were subjected to pancreas transplantation. After twenty weeks, the duct-ligated pancreas transplant was studied morphometrically to determine the effect of duct occlusion on the various cell populations of the islets. Concomitantly, the streptozotocin-treated host pancreas was examined for a possible influence of the graft on the diabetic pattern of islet cell population. Twenty weeks after pancreas transplantation, the volume fractions of insulin, glucagon, somatostatin and pancreatic polypeptide cells in the graft islets did not differ from those of the normal control pancreas. In the pancreas of nontransplanted diabetic rats, insulin-positive B cells were reduced from 60-65% to less than 10% of the islet volume, whereas non-B cells were significantly increased in volume density. The changes in fractional volume of the various islet cells correlated fairly well with changes in plasma concentration of the corresponding pancreas hormones. In the recipient's own pancreas, the relative volumes of glucagon and somatostatin cells were unaffected by the pancreas transplant. However, the insulin cell mass was significantly increased, and comprised about 20% of the islet volume, while cells containing pancreatic polypeptide were found only sporadically.

Effect of pancreas transplantation on liver carbohydrate metabolism in streptozotocin diabetic rats

The failure of pancreas transplantation to normalize plasma glucagon concentration and insulin: glucagon balance in portal blood has recently been demonstrated on streptozotocin-diabetic rats. The same experimental model was used in the present study to examine the effect of pancreas transplantation on liver carbohydrate metabolism. Twenty weeks after pancreas transplantation, the left hepatic lobe was removed for studies of several glycolytic and gluconeogenic enzymes. Livers from nontransplanted diabetic rats showed decreased activities of glycolytic enzymes and enhanced activities of gluconeogenic enzymes. In recipients of pancreas transplants, however, the activities of glycolytic and gluconeogenic enzymes did not differ from those observed in normal control rats. It is concluded that the alterations of hepatic gluconeogenesis and glycolysis observed in streptozotocin-diabetic rats are restored to normal by the pancreas transplant despite its failure to obviate hyperglucagonaemia.

Long-term effect of pancreas transplantation on diabetic hyperglucagonemia

Pancreas isotransplantation was performed on streptozotocin-diabetic Wistar rats. To study the influence of the graft on diabetic hyperglucagonemia, immunoreactive glucagon (IRG) and its response to alanine (peak IRG) were determined in peripheral blood at intervals for up to 8 months after the transplantation. Concentrations of IRG and immunoreactive insulin (IRI) in effluent blood from host pancreas (portal vein) and graft (caval vein) were measured 4 months after the transplantation to estimate the hormone release from both organs. Following transplantation, caval IRI increased sixfold. Portal IRI increased 180% and reached 65% of the concentration observed in control rats. Peripheral basal and peak IRG were initially restored to normal, but were later increased to levels equal to those of diabetic rats. Also portal and caval IRG concentrations were similar in recipients and diabetic rats. The results show that relatively small amounts of glucagon are released from the graft, and that the exaggerated glucagon release from the host pancreas is only transiently normalized following pancreas transplantation.

Kallikrein in rat pancreatic tissue after beta cell destruction or acinar cell atrophy

The purpose of this study was to determine whether glandular kallikrein in rat pancreas is located in the beta cells of the endocrine pancreas or in the acinar cells of the exocrine pancreas. Kallikrein was measured by radial immunodiffusion and a direct radioimmunoassay in homogenates of pancreas obtained from 1) control rats, 2) rats with pancreatic beta cells selectively destroyed by streptozotocin, and 3) rats with acinar cell atrophy induced by pancreatic duct occlusion. Beta cell destruction was confirmed by the presence of hyperglycemia and by an almost total depletion of insulin-producing cells as demonstrated immunohistochemically. Acinar cell atrophy was confirmed histologically and by an almost total depletion of trypsin-like enzymes in pancreatic homogenates. The concentration of kallikrein in pancreatic homogenates was unchanged after beta cell destruction, whereas it was greatly decreased following acinar cell atrophy. Kallikrein was, by immunohistochemistry, demonstrated in the acinar cell only. The immunohistochemical localization of kallikrein agrees with the above results. These studies strongly indicate that kallikrein is predominantly located in the acinar cells of the exocrine pancreas.