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BMJ (Clinical Research Ed.) Apr 2017The treatment of patients with diabetes mellitus (DM) presents many challenges to care providers and represents a major proportion of healthcare expenditure worldwide.... (Review)
Review
The treatment of patients with diabetes mellitus (DM) presents many challenges to care providers and represents a major proportion of healthcare expenditure worldwide. Successful pancreas transplantation provides durable glycemic control and improves survival for patients with diabetes. Progress in the field has mainly been based on large single center studies and the cumulative analyses of registry data from the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry. This review focuses on the outcomes of pancreas transplantation for patients with and without end stage renal disease. It describes the current state of pancreas transplantation, gaps in knowledge, and future studies needed to enable more patients to benefit from this treatment. A common theme that emerges is the need for multicenter randomized trials in pancreas transplantation to define clearly the efficacy, risks, and long term benefits.
Topics: Diabetes Mellitus, Type 1; Diabetic Nephropathies; Humans; Kidney Transplantation; Pancreas Transplantation; Pancreas, Artificial; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 28373161
DOI: 10.1136/bmj.j1321 -
Current Opinion in Organ Transplantation Aug 2021To define recent changes and future directions in the practice of pancreas transplantation (PT). Two major events have occurred in the past 18 months: COVID-19... (Review)
Review
PURPOSE OF REVIEW
To define recent changes and future directions in the practice of pancreas transplantation (PT). Two major events have occurred in the past 18 months: COVID-19 pandemic, and the first world consensus conference on PT. Several innovative studies were published after the consensus conference.
RECENT FINDINGS
During COVID-19 pandemic PT activity decreased. COVID-19 in transplant recipients increases mortality rates, but data from kidney transplantation show that mortality might be higher in waitlisted patients.The world consensus conference provided 49 jury deliberations on the impact of PT on management of diabetic patients and 110 practice recommendations.Recent evidence demonstrates that PT alone is safe and effective, that results of simultaneous pancreas and kidney (SPK) remain excellent despite older recipient age and higher prevalence of type 2 diabetes, that use of hepatitis C virus (HCV)-positive donors into HCV-negative recipients is associated with good outcomes, and that use of sirolimus as primary immunosuppressant and costimulation blockade does not improve results of SPK.
SUMMARY
COVID-19 pandemic and the first world consensus conference on PT were major events. Although COVID-19 pandemic should not reduce PT activity in the future, a major positive impact on both volume and outcomes of PT is awaited from the proceedings of the world consensus conference.
Topics: COVID-19; Consensus Development Conferences as Topic; Donor Selection; Graft Survival; Humans; Kidney Transplantation; Pancreas Transplantation; SARS-CoV-2; Transplant Recipients
PubMed: 34101665
DOI: 10.1097/MOT.0000000000000900 -
Gastroenterology Clinics of North... Mar 2012SPK transplant is the definitive treatment of type 1 diabetes combined with end-stage renal disease. Long-term graft function can lead to improvement in diabetes-related... (Review)
Review
SPK transplant is the definitive treatment of type 1 diabetes combined with end-stage renal disease. Long-term graft function can lead to improvement in diabetes-related complications and, in patients younger than 50 years, can lead to improved overall survival. PAK transplant and PA transplant do not result in similar improvements in patient survival, but with appropriate patient selection, they can improve quality of life by rendering patients insulin-free. Pancreas transplant is associated with more surgical complications and higher perioperative morbidity and mortality than KTA. Therefore, careful donor and recipient selection along with meticulous surgical technique are mandatory for optimal outcomes.
Topics: Diabetes Complications; Humans; Pancreas Transplantation
PubMed: 22341254
DOI: 10.1016/j.gtc.2011.12.002 -
Lancet (London, England) May 2009Since the introduction of pancreas transplantation more than 40 years ago, efforts to develop more minimally invasive techniques for endocrine replacement therapy have... (Review)
Review
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.
Topics: Coronary Disease; Diabetes Complications; Graft Rejection; Graft Survival; Histocompatibility Testing; Humans; Immunosuppression Therapy; Kidney Failure, Chronic; Morbidity; Pancreas Transplantation; Patient Selection; Quality of Life; Survival Rate; Tissue and Organ Procurement; Transplantation Immunology; Treatment Outcome
PubMed: 19465236
DOI: 10.1016/S0140-6736(09)60609-7 -
Current Diabetes Reports Nov 2019Beta-cell replacement is the best therapeutic option for patients with type 1 diabetes. Because of donor scarcity, more extended criteria donors are used for... (Review)
Review
PURPOSE OF REVIEW
Beta-cell replacement is the best therapeutic option for patients with type 1 diabetes. Because of donor scarcity, more extended criteria donors are used for transplantation. Donation after circulatory death donors (DCD) are not commonly used for pancreas transplantation, because of the supposed higher risk of complications. This review gives an overview on the pathophysiology, risk factors, and outcome in DCD transplantation and discusses different preservation methods.
RECENT FINDINGS
Studies on outcomes of DCD pancreata show similar results compared with those of donation after brain death (DBD), when accumulation of other risk factors is avoided. Hypothermic machine perfusion is shown to be a safe method to improve graft viability in experimental settings. DCD should not be the sole reason to decline a pancreas for transplantation. Adequate donor selection and improved preservation techniques can lead to enhanced pancreas utilization and outcome.
Topics: Death; Diabetes Mellitus, Type 1; Donor Selection; Graft Survival; Humans; Organ Preservation; Pancreas Transplantation; Retrospective Studies; Risk Factors; Tissue Donors; Treatment Outcome
PubMed: 31741132
DOI: 10.1007/s11892-019-1238-y -
The Surgical Clinics of North America Oct 1994During the past decade, marked improvement has been made in the field of pancreas transplantation. The best results have been obtained in patients receiving a... (Review)
Review
During the past decade, marked improvement has been made in the field of pancreas transplantation. The best results have been obtained in patients receiving a simultaneous pancreas-kidney transplant using the bladder drainage technique. An overall improvement in the secondary complications of diabetes has been documented in patients receiving successful pancreatic grafts. Pancreatic islet cell transplantation remains largely experimental at this time.
Topics: Diabetes Complications; Diabetes Mellitus; Graft Survival; Humans; Immunosuppression Therapy; Islets of Langerhans Transplantation; Kidney Transplantation; Pancreas Transplantation; Survival Rate; Tissue and Organ Procurement
PubMed: 7940068
DOI: No ID Found -
Current Opinion in Organ Transplantation Aug 2018Robotic pancreas transplantation is a novel procedure that aims to reduce surgical invasiveness, and thereby limit complications related to the surgical access. Given... (Review)
Review
PURPOSE OF REVIEW
Robotic pancreas transplantation is a novel procedure that aims to reduce surgical invasiveness, and thereby limit complications related to the surgical access. Given that few centers are providing robotic transplantation, this review serves as a state of the science article to outline early experiences and highlight areas for future research.
RECENT FINDINGS
Pancreas transplantation results in relatively high rates of wound and other surgical complications that are known to deleteriously impact outcomes. The minimally invasive, robotic-assisted approach decreases wound complications. Because of the obesity epidemic, overweight and obese status is encountered in an increasing number of transplant candidates. These candidates are subject to increased wound-related complications and most benefit from a robotic approach. The first clinical reports on laparoscopic, robotic-assisted kidney and pancreas transplantation indicate a significant decrease in wound complications and excellent outcomes in obese patients otherwise denied access to transplantation.
SUMMARY
With excellent results achieved in surgically challenging patients and further accumulation of experience, laparoscopic, robotic-assisted pancreas and kidney transplantation may evolve to a new standard approach.
Topics: Humans; Laparoscopy; Pancreas Transplantation; Review Literature as Topic; Robotic Surgical Procedures
PubMed: 29979265
DOI: 10.1097/MOT.0000000000000555 -
Current Opinion in Organ Transplantation Aug 2018Pancreas transplantation in type 2 diabetes mellitus (T2DM) candidates remains disproportionately lower than in type 1 diabetes mellitus (T1DM); however, outcomes in... (Review)
Review
PURPOSE OF REVIEW
Pancreas transplantation in type 2 diabetes mellitus (T2DM) candidates remains disproportionately lower than in type 1 diabetes mellitus (T1DM); however, outcomes in carefully selected patients mirrors that of T1DM. Despite the 2014 United Network for Organ Sharing (UNOS) eligibility criteria for simultaneous pancreas/kidney transplant (SPK) transplantation in T2DM patients, an expected increase in the number of transplants was not observed.
RECENT FINDINGS
In an updated International Pancreas and Transplant Registry (IPTR) analysis, 1514 primary deceased donor pancreas transplants were performed in T2DM recipients [1995-2015, SPK 88%, pancreas after kidney (PAK) 9%, pancreas transplant alone (PTA) 3%]. In contrast to the declining number of SPK transplants for T1DM, the number of primary SPK transplants in T2DM patients is increasing over time in the USA. Improvement over time was noted for T2DM SPK patient and graft survival, and the rate of technical failures decreased, paralleling similar overall trends for pancreas transplants in general. Long-term follow-up data of pancreas outcomes in C-peptide positive vs. negative demonstrate noninferior outcomes. BMI does not appear to impact outcomes in carefully selected T2DM candidates.
SUMMARY
The current UNOS regulations that currently limit access of T2DM to pancreas transplantation based on strict BMI criteria and C-peptide levels need to be liberated.
Topics: Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Graft Survival; Humans; Kidney Transplantation; Pancreas Transplantation; Patient Selection
PubMed: 29916848
DOI: 10.1097/MOT.0000000000000553 -
Journal of the Royal Society of Medicine Apr 2016The potential to reverse diabetes has to be balanced against the morbidity of long-term immunosuppression associated with transplantation. For a patient with renal... (Review)
Review
The potential to reverse diabetes has to be balanced against the morbidity of long-term immunosuppression associated with transplantation. For a patient with renal failure, the treatment of choice is often a simultaneous transplant of the pancreas and kidney or pancreas after kidney. For a patient with glycaemic instability, choices between a solid organ or islet transplant have to be weighed against benefits and risks of remaining on insulin. Results of simultaneous transplant of the pancreas and kidney transplantation are comparable to other solid-organ transplants, and there is evidence of improved quality of life and life expectancy. There is some evidence of benefit with respect to the progression of secondary diabetic complications in patients with functioning transplants for several years.
Topics: Diabetes Mellitus; Glycemic Index; Humans; Kidney Transplantation; Pancreas Transplantation; Quality of Life; Survival Rate
PubMed: 27059905
DOI: 10.1177/0141076816636369 -
Current Opinion in Organ Transplantation Aug 2019To summarize the existing body of literature regarding quality of life after pancreas transplantation, discuss the limitations of existing studies and make an argument... (Review)
Review
PURPOSE OF REVIEW
To summarize the existing body of literature regarding quality of life after pancreas transplantation, discuss the limitations of existing studies and make an argument for the need for future investigation on this important topic using standard verifiable instruments and utility measurements.
RECENT FINDINGS
Reinvigorating support for pancreas transplantation as a life-extending and quality-of-life-enhancing treatment for complicated diabetes mellitus remains a work in progress. Over the past two decades, improvements in surgical management, donor selection, recipient selection and immunosuppression have dramatically improved patient and graft outcomes, achieving durable restoration of normal glucose homeostasis in over 90% of patients. These significant advances in the field of pancreas transplantation have presumably had a positive effect on quality of life of pancreas recipients in the current era; however, this remains unconfirmed.
SUMMARY
Technical success in pancreas transplantation has improved dramatically since quality of life was last vigorously investigated in pancreas transplant recipients. Comprehensive review of the literature demonstrates the need and potential usefulness of further study substantiating quality of life benefit after pancreas transplantation, as it remains one of the primary considerations for this procedure.
Topics: Humans; Pancreas Transplantation; Quality of Life
PubMed: 31246747
DOI: 10.1097/MOT.0000000000000676