-
Clinical Transplantation Feb 2018The benefits of pancreas transplantation are often difficult to measure. Here, we sought to determine the difference in quality of life for diabetic patients with and...
Successful pancreas transplantation alone is associated with excellent self-identified health score and glucose control: A retrospective study from a high-volume center in the United States.
BACKGROUND
The benefits of pancreas transplantation are often difficult to measure. Here, we sought to determine the difference in quality of life for diabetic patients with and without a functional pancreas transplant alone (PTA).
METHODS
Pancreas transplant alone cases from 1993 to 2015 were considered. An IRB-approved survey inclusive of 15 questions spanning four domains was employed. Chi-square, Fisher's exact, and the T test were used where appropriate.
RESULTS
A total of 137 PTAs were performed during the study period. Of those reached (n = 32), 94% responded to the survey. Self-reported health scores were better (2.1 vs 3.0) for those with functioning pancreata (n = 18) vs those with a non-functional pancreas (n = 14), respectively (P = .036). Those with a functional pancreas had a HgbA1c of 5.3, vs 7.7 for a non-functional pancreas (P = .016). Significant hypoglycemia was reported in two of 18 with a functional transplant vs nine of 14 patients with a failed transplant (P = .003). Daily frustration with blood sugar affecting quality of life was significantly higher for patients with non-functional pancreas grafts (P < .001).
CONCLUSIONS
Pancreas transplantation alone is associated with better glucose control than insulin. In addition, recipients of functional PTAs have improved quality of life and better overall health scores than those with failed grafts.
Topics: Adult; Female; Follow-Up Studies; Glucose; Graft Survival; Health Status; Hospitals, High-Volume; Humans; Hyperglycemia; Hypoglycemia; Male; Middle Aged; Pancreas Transplantation; Prognosis; Quality of Life; Young Adult
PubMed: 29226480
DOI: 10.1111/ctr.13177 -
Experimental and Clinical... Jan 2022Pancreas transplantation is associated with good long-term outcomes, but readmissions are frequent. In this study, our objective was to understand the effects of...
OBJECTIVES
Pancreas transplantation is associated with good long-term outcomes, but readmissions are frequent. In this study, our objective was to understand the effects of operation start time on postoperative outcomes.
MATERIALS AND METHODS
We conducted a retrospective review of all patients who underwent deceased donor pancreas transplant in a single center from January 2017 to December 2018. We compared postoperative outcomes of patients in relation to operation start time, which included morning (6 AM to 3 PM), afternoon (3 PM to 7 PM), and evening (7 PM to 6 AM).
RESULTS
Eighty-three patients were included in the study. The median age was 45 years old, 54.2% were males, and 79.5% had diabetes mellitus type 1. With regard to surgery start time, 50 patients (60.2%) had a start time in the morning, 25 patients (30.1%) in the afternoon, and 8 (9.6%) in the evening. Patients in the morning group had a significantly lower readmission rate compared with the afternoon and evening groups, respectively (50% vs 84% vs 87.5%; P = .04).There were no significant differences in reoperation rate (26% vs 32% vs 12.5%; P = .57), percutaneous drain placement (20% vs 12% vs 12.5%; P = .75), or graft failure (8% vs 4% vs 12.5%; P = .55) among the 3 groups.
CONCLUSIONS
Morning operative start times were associated with lower readmission after pancreas transplant.
Topics: Female; Humans; Male; Middle Aged; Pancreas Transplantation; Patient Readmission; Reoperation; Retrospective Studies; Treatment Outcome
PubMed: 35060450
DOI: 10.6002/ect.2021.0319 -
Transplant International : Official... 2022Simultaneous pancreas-kidney transplantation (SPKT) leads to increased survival and quality of life, and is an alternative treatment for insulin-dependent diabetes...
Simultaneous pancreas-kidney transplantation (SPKT) leads to increased survival and quality of life, and is an alternative treatment for insulin-dependent diabetes mellitus and end-stage kidney disease. Due to the particularities of this population (often with multiple comorbidities) and of the surgery (only performed in a few centers), a comprehensive analysis of patients' experience along the SPKT process is crucial to improve patient care and add value to this procedure. Therefore, we applied a systematic and iterative methodology with the participation of both patients and professional teams working together to explore and identify unmet needs and value-adding steps along the transplant patient journey at an established pancreas transplant program. Four main steps (to comprehend, to explore, to experiment and to assess) led to several interventions around three major areas: Administration and logistics, information and communication, and perceived quality of assistance. As a result, both displacements to the hospital for diagnostic purposes and the time delay involved in joining the patient waiting list for transplantation were reduced in parallel to the administrative procedures. In conclusion, the methodological implementation of key organizational changes has great impact on overall patient experience. Further quantitative analysis from the patient's perspective will consolidate our program and may add new prototype service design components.
Topics: Humans; Kidney Transplantation; Pancreas; Pancreas Transplantation; Patient Outcome Assessment; Quality of Life
PubMed: 35497883
DOI: 10.3389/ti.2022.10223 -
World Journal of Surgery Nov 2023Whole pancreas transplantation provides durable glycemic control and can improve survival rate; however, it can carry an increased risk of surgical complications. One...
BACKGROUND
Whole pancreas transplantation provides durable glycemic control and can improve survival rate; however, it can carry an increased risk of surgical complications. One devastating complication is a duodenal leak at the site of enteroenteric anastomosis. The gastroduodenal artery (GDA) supplies blood to the donor duodenum and pancreas but is commonly ligated during procurement. Since we have not had expressive changes in pancreatic back table surgical techniques in the recent decades, we hypothesized whether back table GDA reconstruction, improving perfusion of the donor duodenum and head of the pancreas, could lead to fewer surgical complications in simultaneous pancreas-kidney (SPK) transplants.
MATERIAL AND METHODS
Between 2017 and 2021, we evaluated demographic information, postoperative complications, intraoperative donor duodenum, recipient bowel O tissue saturation, and patient morbidity through the Comprehensive Complication Index (CCI®).
RESULTS
A total of 26 patients were included: 13 underwent GDA reconstruction (GDA-R), and 13 had GDA ligation (GDA-L). There were no pancreatic leaks in the GR group compared to 38% (5/13) in the GDA-L group (p = 0.03913). Intraoperative tissue oxygen saturation was higher in the GDA-R group than in the GDA-L (95.18 vs.76.88%, p < 0,001). We observed an increase in transfusion rate in GDA-R (p < 0.05), which did not result in a higher rate of exploration (p = 0.38). CCI® patient morbidity was also significantly lower in the GDA-R group (s < 0.05).
CONCLUSIONS
This study identified improved intraoperative duodenal tissue oxygen saturation in the GDA-R group with an associated reduction in pancreatic leaks and CCI® morbidity risk. A larger prospective multicenter study comparing the two methods is warranted.
Topics: Humans; Pancreas Transplantation; Prospective Studies; Duodenum; Pancreas; Hepatic Artery
PubMed: 37700108
DOI: 10.1007/s00268-023-07149-4 -
Transplant International : Official... Oct 2013Outcomes of old-donor simultaneous pancreas-kidney transplantation (SPKT) have not been thoroughly studied. Scientific Registry of Transplant Recipients data reported...
Outcomes of old-donor simultaneous pancreas-kidney transplantation (SPKT) have not been thoroughly studied. Scientific Registry of Transplant Recipients data reported for SPKT candidates receiving dialysis wait-listed between 1993 and 2008 (n = 7937) were analyzed for outcomes among those who remained listed (n = 3301) and of SPKT recipients (n = 4636) using multivariable time-dependent regression models. Recipients were stratified by donor/recipient age (cutoff 40 years) into: young-to-young (n = 2099), young-to-old (n = 1873), old-to-young (n = 293), and old-to-old (n = 371). The overall mortality was 12%, 14%, 20%, and 24%, respectively, for those transplanted, and 50% for those remaining on the waiting list. On multivariable analysis, old-donor SPKT was associated with significantly higher overall risks of patient death, death-censored pancreas, and kidney graft failure in both young (73%, 53%, and 63% increased risk, respectively) and old (91%, 124%, and 85% increased risk, respectively) recipients. The adjusted relative mortality risk was similar for recipients of old-donor SPKT compared with wait-listed patients including those who subsequently received young-donor transplants (aHR 0.95; 95% CI 0.78, 1.12) except for candidates in OPOs with waiting times ≥604 days (aHR 0.65, 95% CI 0.45-0.94). Old-donor SPKT results in significantly worse graft survival and patient mortality without any waiting-time benefit as compared to young-donor SPKT, except for candidates with expected long waiting times.
Topics: Adolescent; Adult; Age Factors; Diabetes Mellitus, Type 1; Female; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Multivariate Analysis; Pancreas Transplantation; Proportional Hazards Models; Registries; Renal Dialysis; Risk Factors; Tissue Donors; Treatment Outcome; United States; Waiting Lists; Young Adult
PubMed: 23819508
DOI: 10.1111/tri.12142 -
BMJ (Clinical Research Ed.) Apr 2001
Review
Topics: Age Factors; Chronic Disease; Humans; Islets of Langerhans Transplantation; Liver Diseases; Liver Failure, Acute; Liver Transplantation; Pancreas Transplantation; Patient Selection; Postoperative Care
PubMed: 11290642
DOI: 10.1136/bmj.322.7290.845 -
Annals of Medicine Apr 1991Pancreatic transplantation for the treatment of diabetes mellitus in man has proved increasingly successful. Between December 1966 and August 1990 2735 pancreas... (Review)
Review
Pancreatic transplantation for the treatment of diabetes mellitus in man has proved increasingly successful. Between December 1966 and August 1990 2735 pancreas transplants from 141 institutions were reported to the International Pancreas Transplant Registry. For the period 1986 to 1989 the one year graft survival rate in 1,200 patients was almost 70%, a significant improvement over the preceding five years. The commonest techniques for the diversion of pancreatic secretions are bladder drainage, intestinal drainage and duct occlusion with synthetic polymers. The survival rate of pancreas grafts is significantly higher in recipients of simultaneous pancreas and kidney transplants than in recipients of pancreas transplants after kidney transplants and transplants of the pancreas alone. For this reason pancreas transplantation is mainly indicated as an adjunct to kidney transplantation, when the patient must be given immunosuppressive treatment in any case. A steady decline in the rate of technical failures and of serious adverse reactions as a result of immunosuppressive treatment will undoubtedly widen the present indications. In most recipients of a pancreas graft the blood glucose and hemoglobin A1c levels become normal or near normal. No convincing evidence of an ameliorating effect on microangiopathic and neuropathic complications has been obtained so far. On the other hand, it is established that pancreas transplantation may prevent the development of glomerular lesions in a simultaneously grafted kidney. Previously, transplantation of pancreas islets in man has not been successful. In 1990, however, in several insulin-dependent, diabetic subjects the intraportal transplantation of islets isolated from cadaver pancreas resulted in significant insulin production, and, in a few patients, it was possible to stop insulin treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Blood Glucose; Diabetes Mellitus; Graft Rejection; Humans; Immunosuppression Therapy; Pancreas Transplantation; Registries; Tissue Donors
PubMed: 2069785
DOI: 10.3109/07853899109148032 -
Cleveland Clinic Journal of Medicine Dec 2018Research continues toward the goal of treating type 1 diabetes by replacing insulin-producing beta cells. Ideally, such treatment would be safe and long-lasting and... (Review)
Review
Research continues toward the goal of treating type 1 diabetes by replacing insulin-producing beta cells. Ideally, such treatment would be safe and long-lasting and would eliminate the need for subcutaneous insulin replacement. This article reviews the current state of beta-cell replacement through transplant of the whole pancreas or of islet cells. It also looks at the "bionic" pancreas and other future challenges.
Topics: Bionics; Diabetes Mellitus, Type 1; Humans; Insulin-Secreting Cells; Islets of Langerhans Transplantation; Pancreas Transplantation
PubMed: 30526754
DOI: 10.3949/ccjm.85a.17088 -
Jejunal or Ileal Exocrine Drainage in Pancreas Transplantation: Impact on Gastrointestinal Function.Experimental and Clinical... Jul 2023Pancreas transplant can have serious complications requiring salvage pancreatectomy, and surgical approaches should be carefully considered, with jejunal or ileal...
OBJECTIVES
Pancreas transplant can have serious complications requiring salvage pancreatectomy, and surgical approaches should be carefully considered, with jejunal or ileal anastomoses most often employed. The jejunum may reduce gastrointestinal disturbance, whereas the ileum is more immunogenic. Proximal gastrointestinal anastomoses pose challenges with salvage pancreatectomy and creation of high-output stoma, often in the context of end-stage renal failure. Here, we compared outcomes between these techniques.
MATERIALS AND METHODS
We retrospectively analyzed patient records of simultaneous pancreas and kidney transplants at a single center between 2013 and 2015, with follow-up to 2020.
RESULTS
Our center performed 86 simultaneous pancreas and kidney transplants during the study period; 10 patients were excluded because of incomplete records of anastomosis type. Of included recipients, 59.2% were men (mean age 41.5 ± 8.4 y), 72.4% were donors after brain death, and 98.7% had received a first pancreas transplant. Forty-three simultaneous pancreas and kidney transplants were performed with ileal anastomosis and 33 with jejunal anastomosis. We found no significant differences in recipient or donor factors or immunosuppression regimen between anastomosis groups and no significant differences in overall patient, pancreas, or kidney graft survival or in gastrointestinal complications. Hospital length of stay was higher with ileal anastomosis (median 14 vs 19 days; P < .05), as was cold ischemic time (median 8:48 vs 9:31 hours; P < .05). Three patients required salvage pancre-atectomy and loop ileostomy formation with multiorgan support, prolonged intensive care unit stay, relaparotomy, and/or laparostomy.
CONCLUSIONS
Long-term outcomes were comparable between our patient groups. Catastrophic complica-tions occur in a minority of cases, requiring salvage surgery. More complications occurred with ileal anastomosis, but this approach allows graft pancreatectomy and formation of loop ileostomy, avoiding a more proximal stoma in clinically unstable patients. Further studies are needed to examine the impact of enteric anastomosis site.
Topics: Male; Humans; Adult; Middle Aged; Female; Pancreas Transplantation; Jejunum; Retrospective Studies; Ileum; Drainage; Graft Survival; Postoperative Complications
PubMed: 37584539
DOI: 10.6002/ect.2022.0342 -
Clinical Transplantation Jan 2018The aim of this study was to assess safety and efficacy of islet transplantation after initial pancreas transplantation with subsequent organ failure. Patients...
The aim of this study was to assess safety and efficacy of islet transplantation after initial pancreas transplantation with subsequent organ failure. Patients undergoing islet transplantation at our institution after pancreas organ failure were compared to a control group of patients with pancreas graft failure, but without islet transplantation and to a group receiving pancreas retransplantation. Ten patients underwent islet transplantation after initial pancreas transplantation failed and were followed for a median of 51 months. The primary end point of HbA1c <7.0% and freedom of severe hypoglycemia was met by nine of 10 patients after follow-up after islet transplantation and in all three patients in the pancreas retransplantation group, but by none of the patients in the group without retransplantation (n = 7). Insulin requirement was reduced by 50% after islet transplantation. Kidney function (eGFR) declined with a rate of -1.0 mL ± 1.2 mL/min/1.73 m per year during follow-up after islet transplantation, which tended to be slower than in the group without retransplantation (P = .07). Islet transplantation after deceased donor pancreas transplant failure is a method that can safely improve glycemic control and reduce the incidence of severe hypoglycemia and thus establish similar glycemic control as after initial pancreas transplantation, despite the need of additional exogenous insulin.
Topics: Adolescent; Blood Glucose; Child; Diabetes Mellitus, Type 1; Female; Follow-Up Studies; Graft Rejection; Graft Survival; Humans; Hypoglycemia; Islets of Langerhans Transplantation; Male; Pancreas Transplantation; Postoperative Complications; Prognosis; Risk Factors; Tissue Donors
PubMed: 29140547
DOI: 10.1111/ctr.13153