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Mervak BM, Roseland ME, Wasnik AP. Pancreatic Transplantation: Surgical Anatomy and Complications. Radiol Clin North Am 2023; 61:821-831. [PMID: 37495290 DOI: 10.1016/j.rcl.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Pancreatic transplantation is a complex surgical procedure performed for patients with chronic severe diabetes, often performed in combination with renal transplantation. Vascular and exocrine drainage anatomy varies depending on the surgical technique. Radiology plays a critical role in the diagnosis of postoperative complications, requiring an understanding of grayscale/Doppler ultrasound as well as computed tomography and MR imaging. In this review, we detail usual surgical methods and normal postoperative imaging appearances. We then review the most common complications following pancreatic transplants, emphasizing diagnostic features of vascular (arterial/venous), surgical, and diffuse parenchymal pathologic conditions on multiple imaging modalities.
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Affiliation(s)
- Benjamin M Mervak
- Division of Abdominal Radiology, Department of Radiology, University of Michigan-Michigan Medicine, University Hospital, B1D502, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Molly E Roseland
- Division of Abdominal Radiology, Department of Radiology, University of Michigan-Michigan Medicine, University Hospital, B1D502, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA; Division of Nuclear Medicine, Department of Radiology, University of Michigan-Michigan Medicine, University Hospital, B1D502, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Ashish P Wasnik
- Division of Abdominal Radiology, Department of Radiology, University of Michigan-Michigan Medicine, University Hospital, B1D502, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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2
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Barnett D, Jolly S, Bhattacharjya S. How to do a spleen preserving porto-splenic pancreas transplantation. ANZ J Surg 2022; 92:3325-3327. [PMID: 36018607 DOI: 10.1111/ans.18004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 12/31/2022]
Abstract
Whole organ pancreas transplantation is a validated technique of the management of insulin sensitive diabetes and its complications. While several techniques have been described for this procedure that carries a significant morbidity and small mortality risk, surgery requires adequately sized vessels to implant the organ. In this paper, the authors describe a novel technique of implantation of the pancreas onto the splenic vessels with concomitant splenic preservation or other visceral vessels that they have employed when traditional implantation sites are not suitable with successful outcome on long term follow up.
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Affiliation(s)
- Dylan Barnett
- Central and Northern Adelaide Renal and Transplantation Service (CNARTS), Royal Adelaide Hospital, Adelaide, Australia.,Department of Surgery, Faculty of Health Sciences, The University of Adelaide, Adelaide, Australia
| | - Samantha Jolly
- Central and Northern Adelaide Renal and Transplantation Service (CNARTS), Royal Adelaide Hospital, Adelaide, Australia.,Department of Surgery, Faculty of Health Sciences, The University of Adelaide, Adelaide, Australia
| | - Shantanu Bhattacharjya
- Central and Northern Adelaide Renal and Transplantation Service (CNARTS), Royal Adelaide Hospital, Adelaide, Australia.,Department of Surgery, Faculty of Health Sciences, The University of Adelaide, Adelaide, Australia
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3
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Jiménez Lasanta J, Garcia Criado M, Garcia Roch C. Informe en los trasplantes renal y pancreático. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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4
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Ferrer-Fàbrega J, Folch-Puy E, Lozano JJ, Ventura-Aguiar P, Cárdenas G, Paredes D, García-Criado Á, Bombí JA, García-Pérez R, López-Boado MÁ, Rull R, Esmatjes E, Ricart MJ, Diekmann F, Fondevila C, Fernández-Cruz L, Fuster J, García-Valdecasas JC. Current Trends in Organ Preservation Solutions for Pancreas Transplantation: A Single-Center Retrospective Study. Transpl Int 2022; 35:10419. [PMID: 35418805 PMCID: PMC8995432 DOI: 10.3389/ti.2022.10419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/25/2022] [Indexed: 12/14/2022]
Abstract
Due to the high vulnerability of the pancreas to ischemia-reperfusion injury, choices regarding preservation solution markedly affect pancreas transplant success. A retrospective single-center analysis of 380 pancreas transplants (2000–2019) was performed to correlate current preservation solutions with transplant outcomes. Early graft failure requiring transplantectomy within 30 days post-transplant occurred in 7.5% for University of Wisconsin (UW) group (n = 267), 10.8% of Celsior (CS) group (n = 83), 28.5% of Histidine-Tryptophan-Ketoglutarate (HTK) group (n = 7), and none for Institut Georges Lopez-1 (IGL-1) group (n = 23). The most common causes of technical failures in this cohort included abdominal hemorrhage (8.4%); graft pancreatitis (3.7%); fluid collections (2.6%); intestinal complications (6.6%); and vascular thrombosis (20.5%). Although IGL-1 solution provided lower surgical complication rates, no significant differences were found between studied groups. Nevertheless, HTK solution was associated with elevated pancreatitis rates. The best graft survival was achieved at 1 year using UW and IGL-1, and at 3 and 5 years using IGL-1 (p = 0.017). There were no significant differences in patient survival after a median follow-up of 118.4 months. In this setting therefore, IGL-1 solution appears promising for perfusion and organ preservation in clinical pancreas transplantation, compared to other commonly used solutions.
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Affiliation(s)
- Joana Ferrer-Fàbrega
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Clinic Institute of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Emma Folch-Puy
- Experimental Pathology Department, Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Consejo Superior de Investigaciones Científicas (CSIC), Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Juan José Lozano
- Bioinformatics Platform, Network for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Barcelona, Spain.,Network for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Barcelona, Spain
| | - Pedro Ventura-Aguiar
- Renal Transplant Unit, Nephrology and Kidney Transplant Department, Hospital Clínic, University of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Gabriel Cárdenas
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Clinic Institute of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - David Paredes
- Donation and Transplant Coordination Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ángeles García-Criado
- Department of Radiology, Hospital Clínic, University of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Josep Antoni Bombí
- Department of Pathology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Rocío García-Pérez
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Clinic Institute of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Miguel Ángel López-Boado
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Clinic Institute of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ramón Rull
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Clinic Institute of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Enric Esmatjes
- Diabetes Unit, Department of Endocrinology and Nutrition, Hospital Clínic, University of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Maria José Ricart
- Renal Transplant Unit, Nephrology and Kidney Transplant Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Fritz Diekmann
- Renal Transplant Unit, Nephrology and Kidney Transplant Department, Hospital Clínic, University of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Constantino Fondevila
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Clinic Institute of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain.,Network for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Laureano Fernández-Cruz
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Clinic Institute of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Josep Fuster
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Clinic Institute of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain.,Network for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Juan Carlos García-Valdecasas
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Clinic Institute of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain.,Network for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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5
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Boggi U, Vistoli F, Andres A, Arbogast HP, Badet L, Baronti W, Bartlett ST, Benedetti E, Branchereau J, Burke GW, Buron F, Caldara R, Cardillo M, Casanova D, Cipriani F, Cooper M, Cupisti A, Davide J, Drachenberg C, de Koning EJP, Ettorre GM, Fernandez Cruz L, Fridell JA, Friend PJ, Furian L, Gaber OA, Gruessner AC, Gruessner RW, Gunton JE, Han D, Iacopi S, Kauffmann EF, Kaufman D, Kenmochi T, Khambalia HA, Lai Q, Langer RM, Maffi P, Marselli L, Menichetti F, Miccoli M, Mittal S, Morelon E, Napoli N, Neri F, Oberholzer J, Odorico JS, Öllinger R, Oniscu G, Orlando G, Ortenzi M, Perosa M, Perrone VG, Pleass H, Redfield RR, Ricci C, Rigotti P, Paul Robertson R, Ross LF, Rossi M, Saudek F, Scalea JR, Schenker P, Secchi A, Socci C, Sousa Silva D, Squifflet JP, Stock PG, Stratta RJ, Terrenzio C, Uva P, Watson CJ, White SA, Marchetti P, Kandaswamy R, Berney T. First World Consensus Conference on pancreas transplantation: Part II - recommendations. Am J Transplant 2021; 21 Suppl 3:17-59. [PMID: 34245223 PMCID: PMC8518376 DOI: 10.1111/ajt.16750] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 02/07/2023]
Abstract
The First World Consensus Conference on Pancreas Transplantation provided 49 jury deliberations regarding the impact of pancreas transplantation on the treatment of diabetic patients, and 110 experts' recommendations for the practice of pancreas transplantation. The main message from this consensus conference is that both simultaneous pancreas-kidney transplantation (SPK) and pancreas transplantation alone can improve long-term patient survival, and all types of pancreas transplantation dramatically improve the quality of life of recipients. Pancreas transplantation may also improve the course of chronic complications of diabetes, depending on their severity. Therefore, the advantages of pancreas transplantation appear to clearly surpass potential disadvantages. Pancreas after kidney transplantation increases the risk of mortality only in the early period after transplantation, but is associated with improved life expectancy thereafter. Additionally, preemptive SPK, when compared to SPK performed in patients undergoing dialysis, appears to be associated with improved outcomes. Time on dialysis has negative prognostic implications in SPK recipients. Increased long-term survival, improvement in the course of diabetic complications, and amelioration of quality of life justify preferential allocation of kidney grafts to SPK recipients. Audience discussions and live voting are available online at the following URL address: http://mediaeventi.unipi.it/category/1st-world-consensus-conference-of-pancreas-transplantation/246.
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6
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Ferrer-Fàbrega J, Fernández-Cruz L. Exocrine drainage in pancreas transplantation: Complications and management. World J Transplant 2020; 10:392-403. [PMID: 33437672 PMCID: PMC7769732 DOI: 10.5500/wjt.v10.i12.392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/23/2020] [Accepted: 12/08/2020] [Indexed: 02/06/2023] Open
Abstract
The aim of this minireview is to compare various pancreas transplantation exocrine drainage techniques i.e., bladder vs enteric. Both techniques have different difficulties and complications. Numerous comparisons have been made in the literature between exocrine drainage techniques throughout the history of pancreas transplantation, detailing complications and their impact on graft and patient survival. Specific emphasis has been made on the early postoperative management of these complications and the related surgical infections and their consequences. In light of the results, a number of bladder-drained pancreas grafts required conversion to enteric drainage. As a result of technical improvements, outcomes of the varied enteric exocrine drainage techniques (duodenojejunostomy, duodenoduodenostomy or gastric drainage) have also been discussed i.e., assessing specific risks vs benefits. Pancreatic exocrine secretions can be drained to the urinary or intestinal tracts. Until the late 1990s the bladder drainage technique was used in the majority of transplant centers due to ease of monitoring urine amylase and lipase levels for evaluation of possible rejection. Moreover, bladder drainage was associated at that time with fewer surgical complications, which in contrast to enteric drainage, could be managed with conservative therapies. Nowadays, the most commonly used technique for proper driving of exocrine pancreatic secretions is enteric drainage due to the high rate of urological and metabolic complications associated with bladder drainage. Of note, 10% to 40% of bladder-drained pancreata eventually required enteric conversion at no detriment to overall graft survival. Various surgical techniques were originally described using the small bowel for enteric anastomosis with Roux-en-Y loop or a direct side-to-side anastomosis. Despite the improvements in surgery, enteric drainage complication rates ranging from 2%-20% have been reported. Treatment depends on the presence of any associated complications and the condition of the patient. Intra-abdominal infection represents a potentially very serious problem. Up to 30% of deep wound infections are associated with an anastomotic leak. They can lead not only to high rates of graft loss, but also to substantial mortality. New modifications of established techniques are being developed, such as gastric or duodenal exocrine drainage. Duodenoduodenostomy is an interesting option, in which the pancreas is placed behind the right colon and is oriented cephalad. The main concern of this technique is the challenge of repairing the native duodenum when allograft pancreatectomy is necessary. Identification and prevention of technical failure remains the main objective for pancreas transplantation surgeons. In conclusion, despite numerous techniques to minimize exocrine pancreatic drainage complications e.g., leakage and infection, no universal technique has been standardized. A prospective study/registry analysis may resolve this.
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Affiliation(s)
- Joana Ferrer-Fàbrega
- HepatoBiliaryPancreatic Surgery and Liver and Pancreas Transplantation Department, ICMDM, Hospital Clinic Barcelona, University of Barcelona, Barcelona Clinic Liver Cancer Group, August Pi i Sunyer Biomedical Research Institute, Barcelona 08036, Barcelona, Spain
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7
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Ferrer-Fàbrega J, Cano-Vargas B, Ventura-Aguiar P, Cárdenas G, García-Criado Á, López-Boado MA, Rull R, García R, Cuatrecasas M, Esmatjes E, Diekmann F, Fondevila C, Ricart MJ, Fernández-Cruz L, Fuster J, García-Valdecasas JC. Early intestinal complications following pancreas transplantation: lessons learned from over 300 cases - a retrospective single-center study. Transpl Int 2020; 34:139-152. [PMID: 33084117 DOI: 10.1111/tri.13775] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/27/2020] [Accepted: 10/16/2020] [Indexed: 01/15/2023]
Abstract
Enteric complications remain a major cause of morbidity in the post-transplant period of pancreas transplantation despite improvements surgical technique. The aim of this single-center study was to analyze retrospectively the early intestinal complications and their potential relation with vascular events. From 2000 to 2016, 337 pancreas transplants were performed with systemic venous drainage. For exocrine secretion, intestinal drainage was done with hand-sewn anastomosis duodenojejunostomy. Twenty-three patients (6.8%) had early intestinal complications. Median age was 39 years (male: 65.2%). Median cold ischemia time was 11 h [IQR: 9-12.4]. Intestinal complications were intestinal obstruction (n = 7); paralytic ileus (n = 5); intestinal fistula without anastomotic dehiscence (n = 3); ischemic graft duodenum (n = 3); dehiscence of duodenojejunostomy (n = 4); and anastomotic dehiscence in jejunum after pancreas transplantectomy (n = 1). Eighteen cases required relaparotomy: adhesiolysis (n = 6); repeated laparotomy without findings (n = 1); transplantectomy (n = 6); primary leak closure (n = 3); re-positioning of the graft (n = 1); and intestinal resection (n = 1). Of the intestinal complications, 4 were associated with vascular thrombosis, resulting in two pancreatic graft losses. Enteric drainage with duodenum-jejunum anastomosis is safe and feasible, with a low rate of intra-abdominal complications. Vascular thrombosis associated with intestinal complications presents a risk factor for the viability of pancreatic grafts, so prevention and early detection is vital.
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Affiliation(s)
- Joana Ferrer-Fàbrega
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Clínic of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Brenda Cano-Vargas
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Clínic of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Pedro Ventura-Aguiar
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Renal Transplant Unit, Nephrology and Kidney Transplant Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Gabriel Cárdenas
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Clínic of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | - Miguel Angel López-Boado
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Clínic of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ramón Rull
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Clínic of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Rocío García
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Clínic of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Miriam Cuatrecasas
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Department of Pathology, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Network for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Barcelona, Spain
| | - Enric Esmatjes
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Diabetes Unit, Department of Endocrinology and Nutrition, Institute Clínic of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Fritz Diekmann
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Renal Transplant Unit, Nephrology and Kidney Transplant Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Constantino Fondevila
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Clínic of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Network for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Barcelona, Spain
| | - Mª José Ricart
- Renal Transplant Unit, Nephrology and Kidney Transplant Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Laureano Fernández-Cruz
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Clínic of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Josep Fuster
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Clínic of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Network for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Barcelona, Spain
| | - Juan Carlos García-Valdecasas
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Clínic of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Network for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Barcelona, Spain
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8
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Yadav K, Stern J, Cholyway R. Pseudocyst of Pancreas Transplant Allograft: A Case Report. Transplant Proc 2020; 52:2831-2834. [PMID: 32859403 DOI: 10.1016/j.transproceed.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/18/2020] [Accepted: 08/02/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pancreatic pseudocysts are rarely reported complications of pancreas transplant. CASE We present a case of a patient with simultaneous pancreas and kidney transplant with bladder exocrine drainage who developed reflux pancreatitis and symptomatic pancreatic pseudocyst as a result of neuropathic bladder, 15 years after the original transplant. He was initially managed with percutaneous aspiration and drainage along with Foley catheter placement to help with bladder emptying. But the pseudocyst recurred after drains and Foley were removed. Eventually, he underwent an enteric conversion of the pancreas allograft with resolution of his symptoms and the pseudocyst. CONCLUSIONS Enteric conversion should be considered in cases of bladder-drained pancreas transplants with recurrent reflux pancreatitis and/or pseudocyst formation.
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Affiliation(s)
- Kunal Yadav
- Division of Transplantation, Department of Surgery, University Hospitals, Cleveland, OH, United States.
| | - Jeffrey Stern
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, United States
| | - Renee Cholyway
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, United States
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9
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Montagud-Marrahi E, Molina-Andújar A, Pané A, Ramírez-Bajo MJ, Amor A, Esmatjes E, Ferrer J, Musquera M, Diekmann F, Ventura-Aguiar P. Outcomes of pancreas transplantation in older diabetic patients. BMJ Open Diabetes Res Care 2020; 8:8/1/e000916. [PMID: 32144128 PMCID: PMC7059452 DOI: 10.1136/bmjdrc-2019-000916] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/27/2020] [Accepted: 02/04/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Improvement in insulin alternatives is leading to a delayed presentation of microvascular and macrovascular complications of diabetes. The objective of this study was to evaluate the long-term outcomes of older (≥50 years) diabetic patients who receive a pancreas transplantation (PT). RESEARCH DESIGN AND METHODS We retrospectively evaluated all 338 PTs performed at our center between 2000 and 2016 (mean follow-up 9.4±4.9 years). Recipient and graft survivals were estimated for up to 10 years after PT. Major adverse cardiovascular events (MACEs) before and after PT were included in the analysis. RESULTS Thirty-nine patients (12%) were ≥50 years old (52.7±2.3 years) at the day of PT, of which 29 received a simultaneous pancreas-kidney transplantation (SPK) and 10 a pancreas after kidney transplantation (PAK). SPK recipients were first transplants, whereas in the PAK up to 50% were pancreas re-transplantations. Recipient and pancreas graft survivals at 10 years were similar between the group <50 years old and the older group for both SPK and PAK (log-rank p>0.05). The prevalence of MACE prior to PT was similar between both groups (31% vs 29%). Following PT, older recipients presented inferior post-transplant MACE-free survival. In a multivariate regression model, diabetes vintage (HR 1.054, p=0.03) and pre-transplantation MACE (HR 1.98, p=0.011), but not recipient age (HR 1.45, p=0.339), were associated with post-transplant MACE. CONCLUSIONS Long-term survival of older pancreas transplant recipients are similar to younger counterparts. Diabetes vintage, but not age, increased the risk of post-transplantation MACE. These results suggest pancreas transplantation is a valuable treatment alternative to older diabetic patients.
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Affiliation(s)
- Enrique Montagud-Marrahi
- Nephrology and Kidney Transplantation Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Alicia Molina-Andújar
- Nephrology and Kidney Transplantation Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Adriana Pané
- Endocrinology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Maria José Ramírez-Bajo
- Laboratori Experimental de Nefrologia I Trasplantament (LENIT), CRB CELLEX, Fundació Clínic, IDIBAPS, Barcelona, Spain
| | - Antonio Amor
- Endocrinology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Enric Esmatjes
- Endocrinology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Joana Ferrer
- Hepatobiliopancreatic and Liver Transplant Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Mireia Musquera
- Urology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Fritz Diekmann
- Nephrology and Kidney Transplantation Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia I Trasplantament (LENIT), CRB CELLEX, Fundació Clínic, IDIBAPS, Barcelona, Spain
| | - Pedro Ventura-Aguiar
- Nephrology and Kidney Transplantation Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Laboratori Experimental de Nefrologia I Trasplantament (LENIT), CRB CELLEX, Fundació Clínic, IDIBAPS, Barcelona, Spain
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10
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Tao SF, Gu WH, Gu JC, Zhu ML, Wang Q, Zheng LZ. A Retrospective Case Series Of High-Intensity Focused Ultrasound (HIFU) In Combination With Gemcitabine And Oxaliplatin (Gemox) On Treating Elderly Middle And Advanced Pancreatic Cancer. Onco Targets Ther 2019; 12:9735-9745. [PMID: 31814733 PMCID: PMC6863124 DOI: 10.2147/ott.s220299] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/18/2019] [Indexed: 12/24/2022] Open
Abstract
Purpose This retrospective study was conducted to evaluate the safety and efficacy of high-intensity focused ultrasound (HIFU) ablation combined with Gemcitabine and Oxaliplatin (Gemox) for the treatment of middle and advanced pancreatic cancer in elderly patients. Methods Forty-seven patients with pancreatic cancer treated with HIFU and Gemox were evaluated for inclusion, and 38 cases were finally included. The primary endpoint was safety. Secondary endpoints included the response rate, the clinical benefit response (CBR), overall survival (OS), progression-free survival (PFS). Results After combination therapy of HIFU and Gemox, severe complications were rarely reported, and no treatment-related death occurred. The rate of three or four-degree myelosuppression was low, and no obvious impairment of hepatorenal function was observed. Pancreatitis and gastrointestinal injury did not occurred. The disease control rate (DCR) was estimated to be 76.3%, including complete remission (CR), partial remission (PR), stable disease (SD) in 1, 6, 22 cases, respectively. And the objective response rate (ORR) was 18.4%. The clinical benefit rate (CBR) was 68.4%, with the pain significantly relieved (P<0.01). The serum level of CA19-9 showed significant changes after HIFU treatment. The median overall survival (OS) was 12.5 months, with a 6-month and 12-month OS rate of 82.13% and 59.34%, respectively. Stratified analyses did not reveal any significant difference between patients in different stages. Conclusion Elderly patients (≥ 60 years old) with pancreatic cancer would experience tolerable toxicity and obtain good clinical benefits from the combination therapy of HIFU ablation and Gemox.
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Affiliation(s)
- Shuang-Fen Tao
- Oncology Department, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, People's Republic of China
| | - Wen-Hua Gu
- Oncology Department, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, People's Republic of China
| | - Jian-Chun Gu
- Oncology Department, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, People's Republic of China
| | - Mei-Ling Zhu
- Oncology Department, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, People's Republic of China
| | - Qing Wang
- Oncology Department, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, People's Republic of China
| | - Lei-Zhen Zheng
- Oncology Department, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, People's Republic of China
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Liao WW, Ling XC, Zhang C, Liu FR, Zhu XF, He XS, Hu AB. Novel surgical technique and efficacy analysis of donor pancreas preparation without vascular reconstruction in pancreas transplantation. J Int Med Res 2019; 47:6182-6191. [PMID: 31500486 PMCID: PMC7045680 DOI: 10.1177/0300060519870894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective Because of the complicated blood supply and vascular structure of the pancreas, blood vessel reconstruction and reshaping are generally required during pancreas transplantation. We modified the vascular preparation procedure for the donor pancreas (i.e., no vascular reconstruction was performed) based on experiences in our department and in other domestic and international transplantation centers. Methods Twelve donor pancreas preparations without vascular reconstruction were performed. The patch (Carrel patch), celiac trunk, and superior mesenteric artery were preserved as arterial inflow channels for the donor pancreas. The common hepatic artery and the gastroduodenal artery were transected at a site 0.5 cm away from the bifurcation. The bifurcated portion was preserved for the donor liver. The stumps of the gastroduodenal artery and common hepatic artery were then ligated. The portal vein was transected in the middle of the hepatoduodenal ligament during separation of the liver and pancreas. The partial portal vein preserved with the pancreas was used as the outflow channel of the donor pancreas. Results The transplanted pancreas functioned well in the recipients, and no vascular complications were reported. Conclusion The overall efficacy of pancreas transplantation without vascular reconstruction has been improved.
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Affiliation(s)
- Wen-Wei Liao
- Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation Center), Guangzhou, China
| | - Xiang-Chao Ling
- Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation Center), Guangzhou, China
| | - Cheng Zhang
- Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation Center), Guangzhou, China
| | - Fu-Rong Liu
- Cardiac Surgery Itensive Care Unit of the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Feng Zhu
- Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation Center), Guangzhou, China
| | - Xiao-Shun He
- Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation Center), Guangzhou, China
| | - An-Bin Hu
- Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation Center), Guangzhou, China
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