Pancreas transplantation.

Department of Hepatopancreatobiliary and Transplantation Surgery, Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, UK.
The Lancet (Impact Factor: 39.21). 06/2009; 373(9677):1808-17. DOI: 10.1016/S0140-6736(09)60609-7
Source: PubMed

ABSTRACT Since the introduction of pancreas transplantation more than 40 years ago, efforts to develop more minimally invasive techniques for endocrine replacement therapy have been in progress, yet this surgical procedure still remains the treatment of choice for diabetic patients with end-stage renal failure. Many improvements have been made in the surgical techniques and immunosuppressive regimens, both of which have contributed to an increasing number of indications for pancreas transplantation. This operation can be justified on the basis that patients replace daily injections of insulin with an improved quality of life but at the expense of a major surgical procedure and lifelong immunosuppression. The various indications, categories, and outcomes of patients having a pancreas transplant are discussed, particularly with reference to the effect on long-term diabetic complications.

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    ABSTRACT: Pancreas-kidney transplantation (PKT) may significantly improve quality of life (HRQOL) in type1 diabetic patients. We have assessed the changes felt by PKT patients, using the GIQLI and EuroQol-5D questionnaires. Patients were asked to compare how their HRQOL had changed from pretransplantation to the last visit. The 60 men and 66 women enrolled had a mean follow-up of 5 years; 84.1% with both grafts, 15.9% with one graft functioning. In all domains of EuroQol-5D scores improved after PKT, as well as the VAS-scale health state (from 38% to 84%, P<0.001; effect size 3.34). In GIQLI, physical function was felt better after PKT than before (14.83±3.86 vs 7.86±4.43, P<0,001; effect size 1.68); the same was observed for psychological status; social function; and GI complaints. Concerning the burden of medical treatment, the score significantly improved (from 1.31 to 3.63, P <0.001, effect size 2.02). The rate of unemployed patients decreased after PKT (from 50.8% to 36.5%, P<0.001). Multivariate analysis showed that having only 1 functioning graft was associated with worse HRQOL scores (B=-5.157, p=0.015). In conclusion, for all assessed domains, patients reported a significant improvement in HRQOL after PKT. Maintenance of the two grafts functioning predicted higher improvement of HRQOL scores.This article is protected by copyright. All rights reserved.
    Clinical Transplantation 01/2015; · 1.49 Impact Factor
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    ABSTRACT: Ischemia-reperfusion injury is a primarily non-allospecific event leading to the depletion of the essential nitric oxide synthase cofactor and potent antioxidant tetrahydrobiopterin. Suboptimal concentrations of tetrahydrobiopterin result in a reduced biosynthesis of nitric oxide leading to vascular endothelial dysfunction. Tetrahydrobiopterin supplementation has been shown to protect from this pathological state in a plethora of cardiovascular diseases including transplant-related ischemia-reperfusion injury. Even though still controversially discussed, there is increasing evidence emerging from both human as well as animal studies that tetrahydrobiopterin-mediated actions rely on its nitric oxide synthase cofactor activity rather than on its antioxidative properties. Herein, we review the current literature regarding the role of tetrahydrobiopterin in ischemia-reperfusion injury including our experience acquired in a murine pancreas transplantation model.
    Pteridines. 01/2013; 24(1).
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    ABSTRACT: Important trends are being observed in pancreas transplantation in the USA. We will describe recent trends in simultaneous pancreas kidney (SPK) transplantation related to immunosuppression, treatment of rejection, and transplantation for patients of advanced age and C-peptide positive diabetes. Rates of pancreas transplantation have declined, despite improved pancreatic graft outcomes. Regarding immunosuppression, trends in SPK transplantation include T-cell depletion induction therapy, waning mammalian target of rapamycin inhibitor use and steroid use in greater than 50% of pancreas transplant recipients with few patients undergoing late steroid weaning. Rejection of the pancreas may be discordant with the kidney after SPK and there is a greater appreciation of antibody-mediated rejection of the pancreas allograft. De-novo donor-specific antibody without graft dysfunction remains an active area of study, and the treatment for this condition is unclear. SPKs are being performed with greater frequency in type 2 diabetes mellitus patients and in patients of advanced age, with exemplary results. The current state of the art in SPK transplantation is yielding superb and improving results.
    Current opinion in organ transplantation. 02/2015; 20(1):94-102.

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