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American Journal of Transplantation :... Jan 2020The overall number of pancreas transplants continued to increase to 1027 in 2018, after a nadir of 947 in 2015. New additions to waiting list remained stable, with 1485... (Review)
Review
The overall number of pancreas transplants continued to increase to 1027 in 2018, after a nadir of 947 in 2015. New additions to waiting list remained stable, with 1485 candidates added in 2018. Proportions of patients with type II diabetes waiting for transplant (14.6%) and undergoing transplant (14.8%) have steadily increased since 2016. Waiting times for simultaneous pancreas/kidney transplant have decreased; median months to transplant was 13.5 for simultaneous pancreas/kidney transplant and 19.7 for pancreas transplant alone in 2018. Outcomes, including patient and kidney survival, as well as rejection rates, have improved consistently over the past several years. Pancreas graft survival data are being collected by the Organ Procurement and Transplantation Network and will be included in a future report once there are sufficient cohorts for analysis.
Topics: Graft Survival; Humans; Pancreas Transplantation; Tissue Donors; Tissue and Organ Procurement; United States; Waiting Lists
PubMed: 31898415
DOI: 10.1111/ajt.15673 -
South Dakota Journal of Medicine Jul 2004Over the last 15 years whole organ pancreas transplantation has emerged as the treatment of choice for selected patients with uremia and Type I Diabetes Mellitus.... (Review)
Review
Over the last 15 years whole organ pancreas transplantation has emerged as the treatment of choice for selected patients with uremia and Type I Diabetes Mellitus. Improvements in surgical technique, better understanding of transplant related complications and advances in immunosuppressive therapy have encouraged the application of this procedure to an increasing number of patients. Pancreas transplantation occurs under three primary scenarios: simultaneous kidney pancreas transplantation, pancreas transplantation after kidney transplantation, and pancreas transplant alone. Overall results are excellent with 90%-95% one-year patient survival, and 85%-90% of patients achieving normal glycemic control. There also exists a significant long-term survival advantage among the simultaneous kidney pancreas transplant group.
Topics: Diabetes Mellitus, Type 1; Humans; Kidney Transplantation; Pancreas Transplantation; Patient Selection
PubMed: 15332321
DOI: No ID Found -
Current Diabetes Reports Jul 2019Pancreas transplantation enables complete patient independence from exogenous insulin administration and increases both patient survival and quality of life. Despite... (Review)
Review
PURPOSE OF REVIEW
Pancreas transplantation enables complete patient independence from exogenous insulin administration and increases both patient survival and quality of life. Despite this, there has been a decline in pancreas transplantation for the past 20 years, influenced by changing donor demographics with more high-risk extended criteria (ECD) and donation after cardiac death (DCD) donors. This review discusses whether the advent of machine perfusion (MP), if extended to the pancreas, can increase the pool of suitable donor organs.
RECENT FINDINGS
Hypothermic and normothermic MP, as forms of preservation deemed superior to cold storage for high-risk kidney and liver donor organs, have opened the avenue for translation of this work into the pancreas. Recent experimental models of porcine and human ex-vivo pancreatic MP are promising. Applications of MP to the pancreas however need refinement-focusing on perfusion protocols and viability assessment tools. Emerging research shows pancreatic MP can potentially offer superior preservation capacity, the ability to both resuscitate and manipulate organs, and assess functional and metabolic organ viability. The future of MP will lie in organ assessment and resuscitation after retrieval, where ultimately organs initially considered high risk and unsuitable for transplantation will be optimised and transformed, making them then available for clinical use, thus increasing the pool of suitably viable pancreata for transplantation.
Topics: Animals; Humans; Organ Preservation; Pancreas Transplantation; Perfusion; Quality of Life; Swine; Tissue Donors
PubMed: 31292740
DOI: 10.1007/s11892-019-1165-y -
Current Diabetes Reports Jul 2018The choice of optimum transplant in a patient with type 1 diabetes mellitus (T1DM) and chronic kidney disease stage V (CKD V) is not clear. The purpose of this review... (Comparative Study)
Comparative Study Review
PURPOSE OF REVIEW
The choice of optimum transplant in a patient with type 1 diabetes mellitus (T1DM) and chronic kidney disease stage V (CKD V) is not clear. The purpose of this review was to investigate this in more detail-in particular the choice between a simultaneous pancreas-kidney transplantation (SPKT) and living donor kidney transplantation (LDKT), including recent evidence, to aid clinicians and their patients in making an informed choice in their care.
RECENT FINDINGS
Analyses of large databases have recently shown SPKT to have better survival rates than a LDKT in the long-term, despite an early increase in morbidity and mortality in SPKT recipients. This survival advantage has only been shown in those SPKT recipients with a functioning pancreas and not those who had early pancreas graft loss. The choice of SPKT or LDKT should not be based on patient and graft survival outcomes alone. Individual patient circumstances, preferences, and comorbidities, among other factors should form an important part of the decision-making process. In general, an SPKT should be considered in those patients not on dialysis and LDKT in those nearing or already on dialysis.
Topics: Comorbidity; Graft Survival; Humans; Kidney Transplantation; Living Donors; Pancreas Transplantation; Treatment Outcome
PubMed: 30030637
DOI: 10.1007/s11892-018-1039-8 -
Transplant International : Official... Apr 2021With a later onset of diabetes complications and thus increasing age of transplant candidates, many centers have extended upper age limits for pancreas transplantation....
With a later onset of diabetes complications and thus increasing age of transplant candidates, many centers have extended upper age limits for pancreas transplantation. This study investigates the effect of recipient and donor age on outcomes after pancreas transplantation.We retrospectively analyzed 565 pancreas transplants performed at two Eurotransplant centers. The cohort was split at a recipient and donor age of 50 and 40 years, respectively. Median recipient age in old patients (≥50 years; 27.2%) was 54 years and 40 years in young patients (<50 years). Compared to young recipients, old recipients had an inferior patient survival rate (≥50: 5yr, 82.8%; 10yr, 65.6%; <50: 5yr, 93.3%; 10yr, 82.0%; P < 0.0001). Old recipients demonstrated comparable death-censored pancreas (≥50: 1yr, 80.6%; 5yr, 70.2%; <50: 1yr, 87.3%; 5yr, 77.8%; P = 0.35) and kidney graft survival (≥50: 1yr, 97.4%; 5yr, 90.6%; <50: 1yr, 97.8%; 5yr, 90.2%; P = 0.53) compared to young recipients. Besides a lower rate of kidney rejection, similar relative risks for postoperative complications were detected in old and young patients. This study shows that despite an increased mortality in old recipients, excellent graft survival can be achieved similar to that of young patients. Age alone should not exclude patients from receiving a pancreas transplant.
Topics: Graft Rejection; Graft Survival; Humans; Kidney Transplantation; Middle Aged; Pancreas Transplantation; Retrospective Studies; Tissue Donors; Treatment Outcome
PubMed: 33570795
DOI: 10.1111/tri.13845 -
Transplant International : Official... Jul 2013Induction therapy, the initial high-dose bolus of immunosuppression given perioperatively to transplant patients, is almost ubiquitous in pancreas transplantation.... (Review)
Review
Induction therapy, the initial high-dose bolus of immunosuppression given perioperatively to transplant patients, is almost ubiquitous in pancreas transplantation. Despite the frequent use, scientific data on the risks and benefits of induction therapy are scarce, especially as it concerns use specifically for pancreas transplantation. Indeed, none of the currently used induction agents are approved as induction therapy for pancreas transplantation, yet potential benefit is largely extrapolated from trials in kidney transplant recipients. This review summarizes which induction therapy agents are available both now and historically, their mechanisms of action, and provides an overview of the published literature describing the use of these agents in simultaneous pancreas-kidney transplant and solitary pancreas transplant recipients. In summary, there are two multicenter randomized trials, several single-center randomized trials, and many other single-center descriptive reports. Overall, the main benefit of induction therapy is the ability to wean steroids earlier, and the main downside is a higher risk of opportunistic infections. Despite a lack of solid evidence, over 90% of pancreas transplants performed annually in the United States receive some type of induction immunosuppression.
Topics: Alemtuzumab; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antilymphocyte Serum; Basiliximab; Humans; Immunosuppressive Agents; Kidney Transplantation; Muromonab-CD3; Pancreas Transplantation; Randomized Controlled Trials as Topic; Recombinant Fusion Proteins
PubMed: 23672537
DOI: 10.1111/tri.12122 -
Cell Transplantation 2021Allocation of donated organs for transplantation is a complex process that considers numerous factors such as donor, organ and candidate characteristics and practical...
Allocation of donated organs for transplantation is a complex process that considers numerous factors such as donor, organ and candidate characteristics and practical issues such as geography. Whole pancreas and isolated islet transplantation are lifesaving for certain individuals with diabetes. Herein, we suggest a revised allocation schema that matches donor characteristics with candidate medical condition while allowing for geographic considerations. It is hoped that adoption of this schema will shorten allocation time, decrease organ waste and optimize the parity between organ donor characteristics and candidate state of health.
Topics: Humans; Islets of Langerhans Transplantation; Middle Aged; Pancreas Transplantation
PubMed: 34757859
DOI: 10.1177/09636897211057130 -
American Journal of Transplantation :... Jun 2015Variant anatomy may be challenging at retrieval, with failure to identify variance being associated with organ damage, particularly vascular damage. On implantation,... (Review)
Review
Variant anatomy may be challenging at retrieval, with failure to identify variance being associated with organ damage, particularly vascular damage. On implantation, some variants demand nonstandard techniques of reconstruction or implantation. This review covers the common and less common anatomical variants of the liver, kidney and pancreas, and gives guidance as to how they may be managed during organ retrieval and implantation.
Topics: Humans; Kidney; Kidney Transplantation; Liver; Liver Transplantation; Organ Transplantation; Pancreas; Pancreas Transplantation; Tissue and Organ Harvesting
PubMed: 25981150
DOI: 10.1111/ajt.13310 -
Transplant International : Official... Jan 2009For reducing the corticosteroid (CS)-related side-effects, especially cardiovascular events, CS-sparing protocols have become increasingly common in pancreas... (Review)
Review
For reducing the corticosteroid (CS)-related side-effects, especially cardiovascular events, CS-sparing protocols have become increasingly common in pancreas transplantation (PT). Lympho-depleting induction antibodies, such as rabbit anti-thymocyte globulin (rATG) or alemtuzumab, have been widely used in successful trials. The results of various CS-sparing protocols combining calcineurin inhibitors (CNI) and mycophenolate or sirolimus, have been mixed for rejection and survival rates. Most of the studies were uncontrolled trials of low-risk patients, therefore the grade of evidence is limited. Large-scale prospective studies with long-term follow up are necessary to assess risks and benefits of CS-sparing regimens in PT before recommending such strategies as standard practice. Islet allo-transplantation for patients with brittle type 1 diabetes mellitus, less invasive and safer procedure than PT, has been attempted since late 1980s, but diabetogenic immunosuppressants at maintenance, mainly CS and high-dose CNI, prevented satisfactory results (10% insulin-independence at 1-year post-transplant). Since 2000, CS-free and CNI-reducing protocols, including more potent induction [daclizumab, OKT3gamma1(ala-ala) anti-CD3 antibody, rATG] and maintenance (sirolimus, mycophenolate) agents, have significantly improved short-term outcomes whereas long-term are still inadequate (from 80% to 20% insulin-independence from 1- to 5-year post-transplant). Main limitations are allo- and autoimmunity, immunosuppression-related islet and systemic toxicity and transplant site unsuitability, which tolerogenic protocols and biotechnological solutions may solve.
Topics: Adrenal Cortex Hormones; Cardiovascular Diseases; Clinical Trials as Topic; Diabetes Mellitus, Type 1; Graft Survival; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Islets of Langerhans Transplantation; Pancreas Transplantation; Substance Withdrawal Syndrome
PubMed: 18855850
DOI: 10.1111/j.1432-2277.2008.00761.x -
Transplantation Proceedings Nov 2011Pancreas preservation by cold storage using University of Wisconsin solution was the mainstay method used for pancreas transplantation during the past 2 decades. Other... (Review)
Review
Pancreas preservation by cold storage using University of Wisconsin solution was the mainstay method used for pancreas transplantation during the past 2 decades. Other solutions, such as HTK, Celsior, and SCOT 15, could not demonstrate any advantage for short preservation periods. But the advent of clinical islet transplantation and the larger use of controlled non-heart-beating donors have prompted the transplantation community to develop methods for increasing pancreas graft quality while preventing ischemic reperfusion damages. Oxygenation by 1- or 2-layer methods during pancreas preservation, as well as the use of perfluorocarbons, might increase the islet yield. Based on the former methods, there is a renewed interest in machine perfusion and oxygenation in pancreas preservation for pancreas transplantation and islet preparation.
Topics: Adenosine; Allopurinol; Glutathione; Humans; Insulin; Islets of Langerhans; Islets of Langerhans Transplantation; Organ Preservation; Organ Preservation Solutions; Oxygen; Pancreas; Pancreas Transplantation; Perfusion; Raffinose
PubMed: 22099806
DOI: 10.1016/j.transproceed.2011.09.052