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Yin H, Arpali E, Leverson GE, Sollinger HW, Kaufman DB, Odorico JS. Ipsilateral versus contralateral placement of the pancreas allograft in pancreas after kidney transplant recipients. Clin Transplant 2018; 32:e13337. [PMID: 29952108 DOI: 10.1111/ctr.13337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 06/08/2018] [Accepted: 06/16/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND In a diabetic, uremic kidney transplant recipient that may receive a future pancreas after kidney (PAK) transplant, the kidney is typically implanted on the left side in anticipation of the subsequent pancreas transplant on the right side. In this study, we sought to determine if ipsilateral PAK (iPAK) is as safe as contralateral PAK (cPAK). METHODS The 115 PAK transplants (iPAK n = 57, cPAK n = 58) were performed from 1997-2010 and results were compared between the groups. RESULTS Kidney graft survival and pancreas graft survival was similar between the two groups. Kidney graft function according to serum creatinine and eGFR was not different between the cPAK and the iPAK groups and there were no episodes of kidney graft thrombosis in either group. Subgroup analyses focusing on donor source also did not show worse outcomes for graft survivals in iPAK group when compared to cPAK group. CONCLUSIONS Pancreas and kidney graft survival in PAK transplants is unaffected by the surgical procedure and iPAK is safe.
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Affiliation(s)
- Hang Yin
- Division of Transplantation, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Emre Arpali
- Division of Transplantation, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Glen E Leverson
- Division of Transplantation, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Hans W Sollinger
- Division of Transplantation, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Dixon B Kaufman
- Division of Transplantation, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Jon S Odorico
- Division of Transplantation, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
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Zaman F, Abreo KD, Levine S, Maley W, Zibari GB. Pancreatic Transplantation: Evaluation and Management. J Intensive Care Med 2016; 19:127-39. [PMID: 15154994 DOI: 10.1177/0885066604263916] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
More than 2 million people in the United States have type 1 diabetes mellitus. Pancreatic transplantation has emerged as the single most effective means of achieving normal glucose homeostasis in this patient population. Newer immunosuppressive agents and surgical techniques continue to evolve, resulting in improved long-term graft and patient survival. Herein, an understanding of the evaluation, technical aspects, and perioperative management of pancreas transplantation is outlined.
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Affiliation(s)
- Fahim Zaman
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana71130, USA.
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3
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Miziara Gonzalez A, Salzedas-Netto AA, Fagundes U, Moura Linhares M, Pompeu Piza Vicentine F, Perdomo Tejada DF, de Jesus Lopes Filho G, Medina Pestana JO, Garcia Oliva CA. Component analysis of hospital cost of pancreas-kidney transplant and correlations with different variables in a Brazilian hospital. Transplant Proc 2015; 46:1836-8. [PMID: 25131048 DOI: 10.1016/j.transproceed.2014.05.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Simultaneous pancreas-kidney transplantation is associated with a high rate of complications when it is compared with transplantation of other organs; these increased complications can result in increased financial costs of the procedure. The objective of this study was to determine operating costs and financial results of simultaneous pancreas-kidney transplantation and its different variables in a Brazilian hospital. PATIENTS AND METHODS Between January 2008 and December 2011, the monthly costs of 105 patients were calculated. These patients were divided into 2 groups; the first consecutive 53 patients were labeled group I and the second set of 52 patients were labeled group II. The cost evaluation was made in US dollars. RESULTS A total of 89 patients corresponded to the public health system and 16 patients to the supplementary health system. The percentage of hospital discharge was 92.4%. There was an increase in operating room costs in group II compared with group I with no statistically significant difference ($18,749.33 for group I and $17,608.26 for group II). The outcome of the operation was positive; it was greater for group II than for group I ($16,303.22 vs $3494.53). CONCLUSIONS Simultaneous pancreas-kidney transplantation is a financially feasible procedure in Brazil, with the public health system being the main payment source.
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Affiliation(s)
- A Miziara Gonzalez
- Division of Abdominal Surgery, Department of Surgery, Federal University of São Paulo, Unifesp; Hospital of Kidney and Hypertension, Fundação Oswaldo Ramos, São Paulo, Brazil.
| | - A A Salzedas-Netto
- Division of Abdominal Surgery, Department of Surgery, Federal University of São Paulo, Unifesp; Hospital of Kidney and Hypertension, Fundação Oswaldo Ramos, São Paulo, Brazil
| | - U Fagundes
- Hospital of Kidney and Hypertension, Fundação Oswaldo Ramos, São Paulo, Brazil
| | - M Moura Linhares
- Division of Abdominal Surgery, Department of Surgery, Federal University of São Paulo, Unifesp; Hospital of Kidney and Hypertension, Fundação Oswaldo Ramos, São Paulo, Brazil
| | - F Pompeu Piza Vicentine
- Division of Abdominal Surgery, Department of Surgery, Federal University of São Paulo, Unifesp
| | - D F Perdomo Tejada
- Division of Abdominal Surgery, Department of Surgery, Federal University of São Paulo, Unifesp
| | - G de Jesus Lopes Filho
- Division of Abdominal Surgery, Department of Surgery, Federal University of São Paulo, Unifesp
| | - J O Medina Pestana
- Hospital of Kidney and Hypertension, Fundação Oswaldo Ramos, São Paulo, Brazil
| | - C A Garcia Oliva
- Division of Abdominal Surgery, Department of Surgery, Federal University of São Paulo, Unifesp
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Salzedas-Netto AA, Gonzalez AM, Fagundes U, Linhares MM, Vicentine FPP, Romero LRN, Martins JL, Pestana JOM, Oliva CAG. Financial cost of the admissions for simultaneous pancreas-kidney transplant in a Brazilian hospital. Acta Cir Bras 2014; 29:748-51. [PMID: 25424296 DOI: 10.1590/s0102-86502014001800009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 09/11/2014] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To perform a cost analysis of simultaneous pancreas-kidney transplantation (SPKT) in a Brazilian hospital. METHODS Between January 2008 and December 2011, 105 consecutive SPKTs at the Hospital of Kidney and Hypertension in Sao Paulo were evaluated. We evaluated the patient demographics, payment source (public health system or supplementary system), and the impact of each hospital cost component. The evaluated costs were corrected to December 2011 values and converted to US dollars. RESULTS Of the 105 SPKT patients, 61.9% were men, and 38.1% were women. Eight patients died, and 97 were discharged (92.4%). Eighty-nine procedures were funded by the public health system. The cost for the patients who were discharged was $18.352.27; the cost for the deceased patients was $18.449.96 (p = 0.79). The FOR for SPKT during this period was positive at $5,620.65. The costs were distributed as follows: supplies, 36%; administrative costs, 20%; physician fees, 15%; intensive care unit, 10%; surgical center, 10%; ward, 9%. CONCLUSION Mortality did not affect costs, and supplies were the largest cost component.
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Chatzizacharias NA, Vaidya A, Sinha S, Smith R, Jones G, Sharples E, Friend PJ. Renal function in type 1 diabetics one year after successful pancreas transplantation. Clin Transplant 2011; 25:E509-15. [PMID: 21999782 DOI: 10.1111/j.1399-0012.2011.01458.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The effect of pancreas transplantation on renal function remains a matter of debate. The purpose of this retrospective, single-unit study is a preliminary analysis of renal function one yr after pancreas transplant (pancreas alone [PTA] or pancreas after kidney [PAK]). Fifty-nine patients were included. Serum creatinine and estimated glomerular filtration rate (eGFR) levels were compared three, six, and 12 months post-transplantation for the whole sample and separately for PTA and PAK and high (>45 mL/min/1.73 m(2)) and low (≤45 mL/min/1.73 m(2)) pre-transplant eGFR subgroups. Overall, eGFR did not change significantly (p = 0.228) at the end of the first year post-transplant, with patients of low initial eGFR presenting a more prominent trend toward stable or improved levels. In the PAK subgroup, eGFR was significantly improved (p = 0.035). High eGFR subgroup demonstrated no significant deterioration in renal function, while patients with low initial eGFR had significantly higher levels 3 (p = 0.012) and six months (p = 0.009) post-transplant. Our study shows that renal function did not deteriorate significantly one yr after pancreas transplant (PTA or PAK), even in patients with substantial pre-existing renal dysfunction. Evaluation at a wider scale and identification of risk factors for potential deterioration are challenges for future research.
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Chatzizacharias NA, Vaidya A, Sinha S, Sharples E, Smith R, Jones G, Brockmann J, Friend PJ. Risk analysis for deterioration of renal function after pancreas alone transplant. Clin Transplant 2011; 26:387-92. [PMID: 21980989 DOI: 10.1111/j.1399-0012.2011.01534.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The risk of progression to renal replacement after pancreas transplant alone (PTA) is a concern in patients with pre-transplant estimated glomerular filtration rate (eGFR) < 70 mL/min/1.73 m(2). This is a retrospective, single-center risk analysis of potential factors affecting renal function after PTA. Twenty-four patients, transplanted over a three-yr period, with functioning pancreatic grafts at the study's end point were included. High tacrolimus levels (> 12 mg/dL) at six months post-transplant was the only independent risk factor identifying a substantial decline in native renal function by Cox regression analysis (HR = 14.300, CI = 1.271-160.907, p = 0.031). The presence of severe pre-transplant proteinuria (urine Pr/Cr ≥ 100 mg/mmol) marginally failed to reach significance (p = 0.056). Low eGFR levels alone (≤ 45 and ≤ 40 mL/min/1.73 m(2)) at the time of transplant did not correlate with substantial decline in renal function. Our data suggest that PTA is a justifiable therapy for patients with hypoglycemia unawareness or other life-threatening diabetic complications, even in those with borderline renal function, provided that they do not suffer from severe proteinuria and appropriate monitoring and tailoring of immunosuppression is ensured.
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Wang SN, Sturdevant M, Kandaswamy R, Gruessner RGW, Sutherland DER, Humar A. Technical failure of the pancreas after SPK transplant: are these patients good candidates for later pancreas retransplant? Clin Transplant 2008; 22:50-4. [PMID: 18217905 DOI: 10.1111/j.1399-0012.2007.00743.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Technical failure of the pancreas graft after a simultaneous pancreas-kidney (SPK) transplant is not uncommon, affecting roughly 10% of SPK recipients. These patients often recover with good kidney function, but have persistent issues related to their diabetes. The aim of this study was to determine if these patients were good candidates for a later pancreas retransplant. Outcomes were compared between 21 PASPK (pancreas after SPK) recipients and 361 recipients of a primary pancreas after kidney (PAK) transplant. Except for kidney graft source, there was no significant difference in the demographic characteristics between these two groups. In general, early surgical complications were more common in PASPK than PAK recipients (47.6% vs. 35.5%, p = 0.15), although the difference was not statistically significant. The incidence of acute rejection was no different between these two groups (28% vs. 33%, p = NS). At three yr post-transplant, patient and pancreas graft survival rates were also no different between the two groups (p = NS). The most common cause for graft loss in both groups was acute or chronic rejection. In conclusion, pancreas retransplant is a viable option for SPK recipients experiencing early technical failure of the pancreas graft. These recipients are not at higher immunologic risk vs. primary PAK recipients.
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Affiliation(s)
- Shen-Nien Wang
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Navarro A, Castro MJ, Cabello M, Aranda JM, Burgos D, Lopez B, Perez A, Solas E. Outcome and morbidity of pancreas transplantation in a single Spanish institution. Transplant Proc 2006; 38:1543-8. [PMID: 16797354 DOI: 10.1016/j.transproceed.2006.02.082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2005] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pancreas transplantation is nowadays the only treatment to reestablish normal blood glucose in diabetic patients. Moreover, transplantation may also prevent and possibly even revert diabetes-related complications. We present our results with the first 4 years of a pancreas transplantation program. MATERIALS AND METHODS From February 2000 to June 2004, we performed 43 pancreas transplants in 42 recipients. In all cases the technique was enteric drainage of the exocrine secretions and systemic venous derivation to the inferior vena cava for endocrine secretions. RESULTS A simultaneous pancreas-kidney transplant was performed in 37 (88.1%) patients, a pancreas after kidney in 4 (9.5%) patients, and a retransplant in 1 (2.4%) patient. Glycosylated hemoglobin and C peptide returned to normal values in all cases. Patient and graft survivals were 91% and 84%, respectively, after a median follow-up of 19 months. The rate of reoperations was 31% with an overall 16% graft loss. CONCLUSIONS Our results were comparable to those of larger series.
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Affiliation(s)
- A Navarro
- Hospital Carlos Haya, Malaga, Spain.
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Navarro-Piñero A, Castro-Santiago MJ, Aranda-Narváez JM, Cabello-Díaz M, Sola-Moyano E, López Rueda B, Pérez-Daga JA, Ramírez-Plaza CP, Burgos-Rodríguez D, González-Molina M, de la Fuente-Perucho A. Trasplante de páncreas: resultados del grupo Málaga. Cir Esp 2006; 79:101-7. [PMID: 16539948 DOI: 10.1016/s0009-739x(06)70828-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Pancreatic transplantation is currently the only therapeutic alternative able to restore normal blood glucose levels in diabetic patients. Moreover, this procedure can halt or even reverse diabetes-related complications. The aim of this study was to present our experience and the results of the first 4 years of a pancreatic transplantation program in our center. MATERIAL AND METHOD From February 2000 to June 2004, 43 pancreatic transplantations were performed in 42 recipients in the Carlos Haya Regional Hospital in Malaga (Spain). In all patients, the technique of enteric drainage of exocrine pancreatic secretions and systemic venous shunting of endocrine secretions (to the inferior vena cava) was used. RESULTS There were 37 (88.1%) simultaneous pancreas-kidney transplantations, 4 (9.5%) in patients with prior kidney transplantation and 1 retransplantation (2.4%). In all patients, glycosylated hemoglobin and C-peptide levels returned to normal. Patient and pancreatic graft survival were 91% and 84%, respectively, with a median follow-up of 19 months. The reintervation rate was 31%, with an overall rate of graft loss of 16%. CONCLUSIONS The results obtained in our series are similar to those reported for large series.
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Affiliation(s)
- Alfonso Navarro-Piñero
- Servicio de Cirugía General, Digestiva y Trasplante de Organos Sólidos Abdominales, Hospital Regional Universitario Carlos Haya, Málaga, Spain.
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Ben-Yehudah A, Witchel SF, Hyun SH, Chaillet JR, Schatten G. Can diabetes be cured by therapeutic cloning? Pediatr Diabetes 2005; 5 Suppl 2:79-87. [PMID: 15601378 DOI: 10.1111/j.1399-543x.2004.00083.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
With the increasing incidence of diabetes mellitus (DM), it is imperative to develop novel treatments. Stem cells offer the potential for use as renewable sources of glucose-responsive, insulin-secreting cells. However, developing a consistent protocol to enrich beta-cells is not a trivial issue. The question whether embryonic, fetal, or adult stem cells offer particular advantages as the starting material remains to be resolved experimentally. While somatic cell nuclear transfer avoids many of the problems associated with heterologous transplantation, the problem of autoimmune destruction of the beta-cells in type 1 DM might still remain. This review summarizes the innovative treatment strategies for DM and considers the possible advantages and problems.
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Affiliation(s)
- Ahmi Ben-Yehudah
- Pittsburgh Development Center, Magee Womens Research Institute, 204 Craft Avenue, Pittsburg, PA 15213, USA
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Abstract
Transplantation of the pancreas or islet cells constitutes surgical treatment for patients with type 1 diabetes mellitus. Pancreas transplantation is now an established procedure for the surgical treatment of diabetes mellitus. Islet cell transplantation has the potential to be the procedure of choice once it becomes more routine because of the minimal surgery involved. Included in this chapter are the pathophysiology of diabetes, rationale for transplantation, and the surgical procedure itself.
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Affiliation(s)
- Karla Larson-Wadd
- Department of Anesthesiology, University of Minnesota Medical Center, Minneapolis, MN 55455, USA
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Tang TH, Li CL, Li X, Jiang FQ, Zhang YK, Ren HQ, Su SS, Jiang GS. Immune tolerance in pancreatic islet xenotransplantation. World J Gastroenterol 2004; 10:1457-61. [PMID: 15133853 PMCID: PMC4656284 DOI: 10.3748/wjg.v10.i10.1457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To observe the effect of tail vein injection with donor hepatocytes and/or splenocytes on the islet xenotransplantation rejection.
METHODS: New-born male pigs and BALB/C mice were selected as donors and recipients respectively. Islet xenotransplantation was performed in recipients just after the third time of tail vein injection with donor hepatocytes and/or splenocytes. Macrophage phagocytosis, NK(natural killing cell) killing activity, T lymphocyte transforming function of spleen cells, antibody forming function of B lymphocytes, and T lymphocyte subsets were taken to monitor transplantation rejection. The effects of this kind of transplantation were indicated as variation of blood glucose and survival days of recipients.
RESULTS: The results showed that streptozotocin (STZ) could induce diabetes mellitus models of mice. The pre-injection of donor hepatocytes, splenocytes or their mixture by tail vein injection was effective in preventing donor islet transplantation from rejection, which was demonstrated by the above-mentioned immunological marks. Each group of transplantation could decrease blood glucose in recipients and increase survival days. Pre-injection of mixture of donor hepatocytes and splenocytes was more effective in preventing rejection as compared with that of donor hepatocyte or splenocyte pre-injection respectively.
CONCLUSION: Pre-injection of donor hepatocytes, splenocytes or their mixture before donor islet transplantation is a good way in preventing rejection.
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Affiliation(s)
- Tian-Hua Tang
- Department of Hemato-oncology, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jingshi Road 89, Jinan 250062, Shandong Province, China
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Penninga L, Webster AC, Egfjord M, Steinbrüchel DA, Gluud C. Antibody immunosuppression for pancreas and kidney-pancreas transplant recipients. Hippokratia 2004. [DOI: 10.1002/14651858.cd004681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Luit Penninga
- Rigshospitalet, Copenhagen University Hospital; Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 3344,; Blegdamsvej 9 Copenhagen Denmark DK-2100
| | - Angela C Webster
- University of Sydney; Sydney School of Public Health; Edward Ford Building A27 Sydney NSW Australia 2006
- University of Sydney at Westmead; Centre for Transplant and Renal Research, Westmead Millennium Institute; Westmead NSW Australia 2145
- The Children's Hospital at Westmead; Cochrane Renal Group, Centre for Kidney Research; Westmead NSW Australia 2145
| | - Martin Egfjord
- Rigshospitalet, Copenhagen University Hospital, Dept 2131; Department of Nephrology; Copenhagen Denmark
| | - Daniel A Steinbrüchel
- Rigshospitalet, Copenhagen University Hospital, Dept 2152; Cardiothoracic Surgery; Blegdamsvej 9 Copenhagen Denmark DK-2100
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 3344, Rigshospitalet, Copenhagen University Hospital; Cochrane Hepato-Biliary Group; Blegdamsvej 9 Copenhagen Denmark DK-2100
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Abstract
INTRODUCTION At the time when organ transplantation occupies a preponderant place in the treatment of many pathologies, the role of the internist in the care of grafted patients remains confidential and poorly defined. PATIENTS AND METHODS A questionnaire was sent to 730 internist practitioners. The aims of this questionnaire were to evaluate 1) their level of knowledge and practice of transplantation; 2) their declared interest on the subject; and finally 3) their perception of the theoretical place of the internists in the transplantation. RESULTS Two hundred twenty-five answered. Although nearly 80% of the practitioners who answered this investigation declared themselves interested in the subject of transplantation, more than 60% considered their theoretical and practical knowledge on the subject to be insufficient. Nearly 70% said they felt ill at ease when faced with a grafted patient in consultation. Nearly two experts out of three considered that the role of the internist in the follow-up of grafted patients should be reinforced but less than 50% of them wished to be more involved, directly and personally. DISCUSSION Whereas grafted patients frequently suffer from polypathologies that could be treated in internal medicine, a majority of internists do not wish to be directly implicated and/or do not feel qualified to treat these patients. The inherent risk in this is to see this specialty gradually excluded from the care networks available to grafted patients.
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Affiliation(s)
- L Fardet
- Service de médecine interne, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine 75571 Paris, France
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