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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 -
Blood Purification 2011Glycemic control via the use of exogenous insulin injections in diabetic patients is incomplete, resulting in multiple long-term complications, such as retinopathy,... (Review)
Review
Glycemic control via the use of exogenous insulin injections in diabetic patients is incomplete, resulting in multiple long-term complications, such as retinopathy, neuropathy, vasculopathy, and nephropathy. The goal of whole-pancreas and kidney transplantation is to achieve long-term insulin independence and correct uremia. The proposed benefits of pancreas and kidney transplantation are improved quality of life, prevention of recurrent diabetic nephropathy, freedom from exogenous insulin, stabilization or improvement in secondary complications, and improved mortality. No other regimen of insulin delivery or renal replacement besides pancreas and kidney transplantation can achieve this level of physiologic regulation.
Topics: Diabetes Mellitus; Diabetic Nephropathies; Graft Survival; Humans; Immunosuppressive Agents; Kidney Transplantation; Pancreas Transplantation; Uremia
PubMed: 21228575
DOI: 10.1159/000321865 -
Transplant International : Official... 2023Thrombosis is a leading causes of pancreas graft loss after simultaneous pancreas kidney (SPK), pancreas after kidney (PAK), and pancreas transplant alone (PTA). There... (Meta-Analysis)
Meta-Analysis Review
Thrombosis is a leading causes of pancreas graft loss after simultaneous pancreas kidney (SPK), pancreas after kidney (PAK), and pancreas transplant alone (PTA). There remains no standardized thromboprophylaxis protocol. The aim of this systematic review and meta-analysis is to evaluate the impact of heparin thromboprophylaxis on the incidence of pancreas thrombosis, pancreas graft loss, bleeding, and secondary outcomes in SPK, PAK, and PTA. Following PRISMA guidelines, we systematically searched BIOSIS®, PubMed®, Cochrane Library®, EMBASE®, MEDLINE®, and Web of Science® on April 21, 2021. Primary peer-reviewed studies that met inclusion criteria were included. Two methods of quantitative synthesis were performed to account for comparative and non-comparative studies. We included 11 studies, comprising of 1,122 patients in the heparin group and 236 patients in the no-heparin group. When compared to the no-heparin control, prophylactic heparinization significantly decreased the risk of early pancreas thrombosis and pancreas loss for SPK, PAK and PTA without increasing the incidence of bleeding or acute return to the operating room. Heparin thromboprophylaxis yields an approximate two-fold reduction in both pancreas thrombosis and pancreas loss for SPK, PAK and PTA. We report the dosage, frequency, and duration of heparin administration to consolidate the available evidence.
Topics: Humans; Heparin; Anticoagulants; Kidney Transplantation; Venous Thromboembolism; Pancreas Transplantation; Pancreas; Thrombosis; Graft Survival
PubMed: 36819126
DOI: 10.3389/ti.2023.10442 -
American Journal of Transplantation :... Jun 2020It has been hypothesized that transplanting simultaneous pancreas kidney (SPK) grafts from donors with a history of cardiac arrest and cardiopulmonary resuscitation...
It has been hypothesized that transplanting simultaneous pancreas kidney (SPK) grafts from donors with a history of cardiac arrest and cardiopulmonary resuscitation (CACPR) leads to inferior posttransplant outcomes due to organ hypoperfusion during cardiac arrest and mechanical trauma during resuscitation. Using Scientific Registry of Transplant Recipients data, we identified 13 095 SPK transplants from 2000-2018, of which 810 (6.2%) were from donors with a history of CACPR. After inverse probability of treatment weighting on donor and recipient characteristics, we found that 1-, 5-, and 10-year patient (CACPR: 96.4%, 89.9%, and 78.9%; non-CACPR: 96.3%, 88.9%, and 76.0%; P = .3), death-censored pancreas graft survival (CACPR: 89.3%, 82.7%, 75.0%; non-CACPR: 89.9%, 82.7%, 76.3%; P = .7), and death-censored kidney graft survival (CACPR: 97.0%, 89.5%, 78.2%; non-CACPR: 96.9.9%, 88.7%, 80.0%; P = .4) were comparable between the two groups. There were no differences in the risk of pancreatitis (CACPR: 2.9%, non-CACPR: 2.4%; weighted OR = 1.22 ; P = .4), anastomotic leak (CACPR: 1.6%, non-CACPR: 2.0%; weighted OR = 1.02 ; P > .9), or median length of hospital stay (CACPR: 8 days, non-CACPR: 9 days; P = .6) for recipients of CACPR vs non-CACPR donors. Our findings suggest that CACPR donors could be used to expand the SPK donor pool without compromising short- or long-term outcomes.
Topics: Graft Survival; Humans; Kidney Transplantation; Pancreas; Pancreas Transplantation; Retrospective Studies; Tissue Donors; Tissue and Organ Procurement
PubMed: 32026618
DOI: 10.1111/ajt.15808 -
American Journal of Transplantation :... Apr 2021
Topics: Diabetes Mellitus, Type 1; Humans; Islets of Langerhans Transplantation; Kidney Transplantation; Pancreas; Pancreas Transplantation
PubMed: 32743962
DOI: 10.1111/ajt.16232 -
Current Diabetes Reports Oct 2012Long-standing type 1 diabetes (T1D) is associated with an absolute loss of endogenous insulin secretion (circulating C-peptide is undetectable) and a related defect in... (Review)
Review
Long-standing type 1 diabetes (T1D) is associated with an absolute loss of endogenous insulin secretion (circulating C-peptide is undetectable) and a related defect in glucose counter-regulation that is often complicated by hypoglycemia unawareness, markedly increasing the risk for severe hypoglycemia. Both the transplantation of isolated islets and a whole pancreas can restore β-cell secretory capacity, improve glucose counter-regulation, and return hypoglycemia awareness, thus alleviating severe hypoglycemia. The transplantation of islets may require more than one donor pancreas, and the recovery of endocrine function for now appears more durable with a whole pancreas; however, islet transplantation outcomes are steadily improving. Because not all patients with T1D experiencing severe hypoglycemia are candidates to receive a whole pancreas, and since not all pancreata are technically suitable for whole organ transplantation, islet and pancreas transplantation are evolving as complementary approaches for the recovery of endocrine function in patients with the most problematic T1D.
Topics: Diabetes Mellitus, Type 1; Humans; Immunosuppressive Agents; Islets of Langerhans Transplantation; Pancreas Transplantation
PubMed: 22763730
DOI: 10.1007/s11892-012-0294-3 -
Diagnostic and Interventional Imaging Oct 2020Pancreas transplantation exposes to high rates of complications, either vascular (thrombosis, stenosis, pseudoaneurysm, arteriovenous fistula) or nonvascular (fluid... (Review)
Review
Pancreas transplantation exposes to high rates of complications, either vascular (thrombosis, stenosis, pseudoaneurysm, arteriovenous fistula) or nonvascular (fluid collection, graft rejection). With advances in percutaneous and endovascular techniques, interventional radiologists are increasingly involved in the management of these complications. In this article, we review the anatomical considerations relevant to pancreas transplantation, the techniques used for image-guided interventions for vascular and nonvascular complications, and the expected outcomes of these interventions.
Topics: Aneurysm, False; Endovascular Procedures; Humans; Pancreas Transplantation; Postoperative Complications; Radiography, Interventional; Radiology, Interventional
PubMed: 32089482
DOI: 10.1016/j.diii.2020.02.002 -
The Journal of Hospital Infection Oct 2022Among hospital-acquired infections, surgical site infections (SSIs) are frequent. SSI in the early post-transplant course poses a relevant threat to transplant...
BACKGROUND
Among hospital-acquired infections, surgical site infections (SSIs) are frequent. SSI in the early post-transplant course poses a relevant threat to transplant recipients.
AIM
To determine incidence, risk factors for SSI and its association with post-transplant outcomes and pancreas transplant (P-Tx) recipients.
METHODS
Adult simultaneous kidney-pancreas transplantation (SPK-T) and P-Tx recipients with a follow-up of at least 90 days were identified in the Swiss Transplant Cohort Study (STCS) dataset. Except for the categorization of SSIs according to Centers for Disease Control and Prevention (CDC) criteria, all other data were prospectively collected. Risk factors for SSI were investigated with logistic regression. A Weibull accelerated failure-time model was applied to address the impact of SSI on length of stay, correcting for transplant-related complications and delayed graft function.
FINDINGS
Of 130 transplant recipients, 108 SPK-Tx and 22 P-Tx, 18 (14%) individuals developed SSI within the first 90 days after transplantation. Deep incisional (seven, 38.9%) and organ/space infections (eight, 44.4%) predominated. In the majority of SSIs (11, 61.1%; two SSIs with simultaneous identification of fungal pathogens) bacteria were detected with Enterococcus spp. being most frequent. The median duration of hospitalization after transplantation was significantly longer in recipients with SSI (median: 26 days; interquartile range (IQR): 19-44) than in patients without SSI (median: 17 days; IQR: 12-25; P = 0.002). In multivariate analysis, SSI was significantly associated with increased length of stay and prolonged the duration of hospitalization by 36% (95% confidence interval: 4-79).
CONCLUSION
SSI after SPK-Tx and P-Tx occurred at a frequency of 14%. Among pathogens, Enterococcus spp. predominated. SSI was independently associated with a longer hospitalization after transplantation.
Topics: Adult; Cohort Studies; Humans; Kidney; Kidney Transplantation; Pancreas; Pancreas Transplantation; Risk Factors; Surgical Wound Infection; Switzerland
PubMed: 35840001
DOI: 10.1016/j.jhin.2022.07.009 -
Kidney International Aug 2022Several organ allocation protocols give priority to wait-listed simultaneous kidney-pancreas (SPK) transplant recipients to mitigate the higher cardiovascular risk of...
Several organ allocation protocols give priority to wait-listed simultaneous kidney-pancreas (SPK) transplant recipients to mitigate the higher cardiovascular risk of patients with diabetes mellitus on dialysis. The available information regarding the impact of preemptive simultaneous kidney-pancreas transplantation on recipient and graft outcomes is nonetheless controversial. To help resolve this, we explored the influence of preemptive simultaneous kidney-pancreas transplants on patient and graft survival through a retrospective analysis of the OPTN/UNOS database, encompassing 9690 simultaneous transplant recipients between 2000 and 2017. Statistical analysis was performed applying a propensity score analysis to minimize bias. Of these patients, 1796 (19%) were transplanted preemptively. At ten years, recipient survival was significantly superior in the preemptive group when compared to the non-preemptive group (78.9% vs 71.8%). Dialysis at simultaneous kidney-pancreas transplantation was an independent significant risk for patient survival (hazard ratio 1.66 [95% confidence interval 1.32-2.09]), especially if the dialysis duration was 12 months or longer. Preemptive transplantation was also associated with significant superior kidney graft survival compared to those on dialysis (death-censored: 84.3% vs 75.4%, respectively; estimated half-life of 38.57 [38.33 -38.81] vs 22.35 [22.17 - 22.53] years, respectively). No differences were observed between both groups neither for pancreas graft survival nor for post-transplant surgical complications. Thus, our results sustain the relevance of early referral for pancreas transplantation and the importance of pancreas allocation priority in reducing patient mortality after simultaneous kidney-pancreas transplantation.
Topics: Diabetes Mellitus, Type 1; Graft Survival; Humans; Kidney Transplantation; Pancreas; Pancreas Transplantation; Retrospective Studies
PubMed: 35644282
DOI: 10.1016/j.kint.2022.04.032 -
Revista Do Colegio Brasileiro de... Mar 2019considering simultaneous pancreas-kidney transplantation cases, to evaluate the financial impact of postoperative complications on hospitalization cost.
OBJECTIVE
considering simultaneous pancreas-kidney transplantation cases, to evaluate the financial impact of postoperative complications on hospitalization cost.
METHODS
a retrospective study of hospitalization data from patients consecutively submitted to simultaneous pancreas-kidney transplantation (SPKT), from January 2008 to December 2014, at Kidney Hospital/Oswaldo Ramos Foundation (Sao Paulo, Brazil). The main studied variables were reoperation, graft pancreatectomy, death, postoperative complications (surgical, infectious, clinical, and immunological ones), and hospitalization financial data for transplantation.
RESULTS
the sample was composed of 179 transplanted patients. The characteristics of donors and recipients were similar in patients with and without complications. In data analysis, 58.7% of the patients presented some postoperative complication, 21.8% required reoperation, 12.3% demanded graft pancreatectomy, and 8.4% died. The need for reoperation or graft pancreatectomy increased hospitalization cost by 53.3% and 78.57%, respectively. The presence of postoperative complications significantly increased hospitalization cost. However, the presence of death, internal hernia, acute myocardial infarction, stroke, and pancreatic graft dysfunction did not present statistical significance in hospitalization cost (in average US$ 18,516.02).
CONCLUSION
considering patients who underwent SPKT, postoperative complications, reoperation, and graft pancreatectomy, as well as surgical, infectious, clinical, and immunological complications, significantly increased the mean cost of hospitalization. However, death, internal hernia, acute myocardial infarction, stroke, and pancreatic graft dysfunction did not statistically interfere in hospitalization cost.
Topics: Adult; Brazil; Costs and Cost Analysis; Female; Hospitalization; Humans; Kidney Transplantation; Male; Pancreas Transplantation; Pancreatectomy; Postoperative Complications; Reoperation; Retrospective Studies; Young Adult
PubMed: 30843947
DOI: 10.1590/0100-6991e-20192096