Pancreas transplantation
This article needs additional citations for verification. (November 2008) |
Pancreas transplantation | |
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ICD-9-CM | 52.8 |
MeSH | D016035 |
MedlinePlus | 003007 |
A pancreas transplant is an
Overview
Because the pancreas is a vital organ, performing functions necessary in the digestion process, the recipient's native pancreas is left in place, and the donated pancreas is attached in a different location. In the event of rejection of the new pancreas, which would quickly cause life-threatening diabetes, there would be a significant chance the recipient would not survive very well for long without the native pancreas, however dysfunctional, still in place. The healthy pancreas comes from a donor who has just died or it may be a partial pancreas from a living donor.
Medical uses
In most cases, pancreas transplantation is performed on people with type 1
Complications
Complications immediately after surgery include clotting of the arteries or veins of the new pancreas (
Types
There are four main types of pancreas transplantation:
- Pancreas transplant alone, for the patient with type 1 diabetes who usually has severe, frequent hypoglycemia, but adequate kidney function. This pancreas transplant known as PTA has as of recently been showing up with good results. This is the least performed method of pancreas transplantation and requires that only the pancreas of a donor is given to the recipient.
- Simultaneous pancreas-kidney transplant(SPK), when the pancreas and kidney are transplanted simultaneously from the same deceased donor. This is the most commonly performed pancreas transplant operation. Indications for an SPK are End Stage Renal Disease with type 1 diabetes (with other diabetic complications like neuropathy, gastroparesis etc.) This is the most common type of pancreas transplantation. The basic reason for this is that patients are mostly already on immunosuppressive drugs and the addition of the kidneys simultaneously reduces the risk in surgical procedure.
- Pancreas-after-kidney transplant (PAK), when a cadaveric, or deceased, donor pancreas transplant is performed after a previous, and different, living or deceased donor kidney transplant. This method is usually recommended for diabetic patients after having a successful kidney transplant. The downside of this procedure is that patients are required to go through surgical risk twice.
- Simultaneous deceased donor pancreas and live donor kidney (SPLK) has the benefit of lower rate of delayed graft function than SPK and significantly reduced waiting times, resulting in improved outcomes.[4]
Prognosis
The prognosis after pancreas transplantation is very good. Over the recent years, long-term success has improved and risks have decreased. One year after transplantation more than 95% of all patients are still alive and 80–85% of all pancreases are still functional. After transplantation patients need lifelong immunosuppression. Immunosuppression increases the risk for a number of different kinds of infection[5] and cancer.
It is unclear if
History
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As described by a pioneer in the field, D.E. Sutherland, whole pancreas transplantation began as a part of multi-organ transplants, in the mid-to-late 1960s, at the University of Minnesota:
The first attempt to cure type 1 diabetes by pancreas transplantation was done at the University of Minnesota, in Minneapolis, on December 17, 1966… [This] opened the door to a period, between the mid 70's to mid 80's where only segmental pancreatic grafts were used... In the late 70's-early 80's, three major events… boosted the development of pancreas transplantation… [At] the Spitzingsee meetings, participants had the idea to renew the urinary drainage technique of the exocrine secretion of the pancreatic graft with segmental graft and eventually with whole pancreaticoduodenal transplant. That was clinically achieved during the mid 80's and remained the mainstay technique during the next decade. In parallel, the Swedish group developed the whole pancreas transplantation technique with enteric diversion. It was the onset of the whole pancreas reign. The enthusiasm for the technique was rather moderated in its early phase due to the rapid development of liver transplantation and the need for sharing vascular structures between both organs, liver and pancreas. During the modern era of immunosuppression, the whole pancreas transplantation technique with enteric diversion became the gold standard…[7]
The first pancreas transplantation, performed in a multi-organ transplant with kidney and duodenum, was into a 28-year-old woman; her death three month post-surgery did not obscure the apparent success of the pancreatic replacement.[8] It was performed in 1966 by the team of W.D. Kelly, R.C. Lillehei, F.K. Merkel, Y. Idezuki, F.C. Goetz and coworkers at the University Hospitals, University of Minnesota, three years after the first kidney transplantation.[9][non-primary source needed] The first living-related partial pancreas transplantation was done in 1979.[clarification needed][according to whom?][citation needed]
In the successive 1980s period, there was significant improvements in immunosuppressive drugs, surgical techniques, and the preservation of organs. The prognosis is very good with 95% of patients still alive after one year post-surgery and 80-85% of all pancreases still functional.[5]
In 2010 Ugo Boggi[10][circular reference] practices state-of-the-art robotic surgery having performed the first world robotic pancreas transplant and the first world robotic distal selective spleno-renal shunt for the treatment of severe portal hypertension.[11]
References
- ^ Type 1 cures – pancreas transplants
- S2CID 40187253.
- S2CID 205042967.
- PMID 11066142.
- ^
- S2CID 35034209.
- S2CID 25795725.
- ^ The patient's blood sugar levels decreased immediately after transplantation. Her later death was attributed to pulmonary embolism. See Kelly, et al., op. cit.[verification needed] and Squifflet et al., op. cit.[verification needed]
- PMID 5338113.
- ^ it:Ugo Boggi
- ^ LS Laparoscopic Surgery
Further reading
- Larsen JL (2004). "Pancreas transplantation: indications and consequences". Endocr Rev. 25 (6): 919–46.