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Rössler F, Kalliola F, de Rougemont O, Hübel K, Hügli S, Viggiani d’Avalos L, Schachtner T, Oberholzer J. Simultaneous Pancreas and Kidney Transplantation from Donors after Circulatory Death in Switzerland. J Clin Med 2024; 13:3525. [PMID: 38930054 PMCID: PMC11204996 DOI: 10.3390/jcm13123525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/08/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Simultaneous pancreas and kidney transplantation (SPK) remains the only curative treatment for type I diabetics with end-stage kidney disease. SPK using donors after circulatory death (DCD) is one important measure to expand the organ pool for pancreas transplantation (PT). After initial doubts due to higher complications, DCD SPK is now considered safe and equivalent to donation after brain death in terms of survival and graft function. Materials and Methods: We assessed pancreas and kidney graft function, as well as complications of the first three patients who underwent a DCD SPK in Switzerland. Two transplantations were after rapid procurement, one following normothermic regional perfusion (NRP). Results: Intra- and postoperative courses were uneventful and without major complications in all patients. In the two SPK after rapid procurement, pancreas graft function was excellent, with 100% insulin-free survival, and hemoglobin A1C dropped from 7.9 and 7.5 before SPK and to 5.1 and 4.3 after three years, respectively. Kidney graft function was excellent in the first year, followed by a gradual decline due to recurrent infections. The patient, after NRP SPK, experienced short-term delayed pancreatic graft function requiring low-dose insulin treatment for 5 days post-transplant, most likely due to increased peripheral insulin resistance in obesity. During follow-up, there was persistent euglycemia and excellent kidney function. Conclusions: We report on the first series of DCD SPK ever performed in Switzerland. Results were promising, with low complication rates and sustained graft survival. With almost half of all donors in Switzerland currently being DCD, we see great potential for the expansion of DCD PT.
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Affiliation(s)
- Fabian Rössler
- Department of Surgery and Transplantation, University Hospital Zurich, 8091 Zurich, Switzerland; (F.K.); (O.d.R.); (S.H.); (L.V.d.); (J.O.)
| | - Fiona Kalliola
- Department of Surgery and Transplantation, University Hospital Zurich, 8091 Zurich, Switzerland; (F.K.); (O.d.R.); (S.H.); (L.V.d.); (J.O.)
| | - Olivier de Rougemont
- Department of Surgery and Transplantation, University Hospital Zurich, 8091 Zurich, Switzerland; (F.K.); (O.d.R.); (S.H.); (L.V.d.); (J.O.)
| | - Kerstin Hübel
- Department of Nephrology, University Hospital Zurich, 8091 Zurich, Switzerland; (K.H.); (T.S.)
| | - Sandro Hügli
- Department of Surgery and Transplantation, University Hospital Zurich, 8091 Zurich, Switzerland; (F.K.); (O.d.R.); (S.H.); (L.V.d.); (J.O.)
| | - Lorenzo Viggiani d’Avalos
- Department of Surgery and Transplantation, University Hospital Zurich, 8091 Zurich, Switzerland; (F.K.); (O.d.R.); (S.H.); (L.V.d.); (J.O.)
| | - Thomas Schachtner
- Department of Nephrology, University Hospital Zurich, 8091 Zurich, Switzerland; (K.H.); (T.S.)
| | - Jose Oberholzer
- Department of Surgery and Transplantation, University Hospital Zurich, 8091 Zurich, Switzerland; (F.K.); (O.d.R.); (S.H.); (L.V.d.); (J.O.)
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Holtmann C, Roth M, Filler T, Bergmann AK, Hänggi D, Muhammad S, Borrelli M, Geerling G. Microvascular anastomosis of the human lacrimal gland: a concept study towards transplantation of the human lacrimal gland. Graefes Arch Clin Exp Ophthalmol 2022; 261:1443-1450. [PMID: 36477647 PMCID: PMC10148775 DOI: 10.1007/s00417-022-05933-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/17/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022] Open
Abstract
Abstract
Introduction
Severe aqueous tear deficiency is caused by primary or secondary main lacrimal gland insufficiency. The transplantation of a human lacrimal gland could become a potential treatment option to provide physiological tears with optimal properties. To this end, we performed an ex vivo study to develop a surgical strategy that would ensure a vascular supply for a lacrimal gland transplant using microvascular techniques.
Material and methods
Five cadaver heads were used to perform a lateral orbitotomy in order to identify the vascular pedicle and the lacrimal gland itself. The principal feasibility and the time of the required surgical steps for an intraorbital microvascular re-anastomosis of the human lacrimal gland were documented. Patency and potential leakage of the anastomosis were tested with hematoxylin intraoperatively. Postoperatively, routine histological, as well as scanning electron microscopy (SEM) of the gland and vascular anastomosis, were performed.
Results
The vascular pedicle of all five glands could be isolated over a minimum stretch of at least 1 cm, severed, and successfully reanastmosed microsurgically. Time for arterial anatomization (n = 4) was 23 ± 7 min and 22 ± 3 min for the vein (p = 0.62). The total time for the entire microvascular anastomosis was 46 ± 9 min. All anastomosis were patent upon testing. SEM revealed well-aligned edges of the anastomosis with tight sutures in place.
Conclusion
Our study demonstrates as proof of principle the feasibility of intraorbital microvascular re-anastomosis of a human lacrimal gland within the presumed window of ischemia of this tissue. This should encourage orbital surgeons to attempt lacrimal gland transplantation in humans in vivo.
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Affiliation(s)
- Christoph Holtmann
- Department of Ophthalmology, University Hospital, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.
| | - Mathias Roth
- Department of Ophthalmology, University Hospital, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Timm Filler
- Institute of Anatomy I, Heinrich-Heine-University Duesseldorf, Universitaetsstr. 1, 40225, Duesseldorf, Germany
| | - Ann Kathrin Bergmann
- Core Facility Elektronenmikroskopie (CFEM), Heinrich-Heine-Universität Duesseldorf, Universitaetsstr. 1, 40225, Duesseldorf, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Hospital, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Sajjad Muhammad
- Department of Neurosurgery, University Hospital, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Maria Borrelli
- Department of Ophthalmology, University Hospital, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Gerd Geerling
- Department of Ophthalmology, University Hospital, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
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