Pancreas transplantation

Pancreatic Transplantation: Evaluation and Management

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.

Embryonic pig pancreatic tissue transplantation for the treatment of diabetes

BACKGROUND

Transplantation of embryonic pig pancreatic tissue as a source of insulin has been suggested for the cure of diabetes. However, previous limited clinical trials failed in their attempts to treat diabetic patients by transplantation of advanced gestational age porcine embryonic pancreas. In the present study we examined growth potential, functionality, and immunogenicity of pig embryonic pancreatic tissue harvested at different gestational ages.

METHODS AND FINDINGS

Implantation of embryonic pig pancreatic tissues of different gestational ages in SCID mice reveals that embryonic day 42 (E42) pig pancreas can enable a massive growth of pig islets for prolonged periods and restore normoglycemia in diabetic mice. Furthermore, both direct and indirect T cell rejection responses to the xenogeneic tissue demonstrated that E42 tissue, in comparison to E56 or later embryonic tissues, exhibits markedly reduced immunogenicity. Finally, fully immunocompetent diabetic mice grafted with the E42 pig pancreatic tissue and treated with an immunosuppression protocol comprising CTLA4-Ig and anti-CD40 ligand (anti-CD40L) attained normal blood glucose levels, eliminating the need for insulin.

CONCLUSIONS

These results emphasize the importance of selecting embryonic tissue of the correct gestational age for optimal growth and function and for reduced immunogenicity, and provide a proof of principle for the therapeutic potential of E42 embryonic pig pancreatic tissue transplantation in diabetes.

[Perception of organ grafts by internists]

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.