Pancreas transplant

Based upon theoretical considerations of the mechanisms of hypothermic-induced cellular injury, we developed the University of Wisconsin organ preservation solution (UW solution) that has had a widespread and dramatic effect on organ preservation (Table 2). Prior to the development of this solution, the liver and pancreas could be preserved for only four to six hours. Thus, there was a large time constraint on liver and pancreas transplantation and many cadaveric organs were wasted. However, the UW solution increased preservation duration to 48 to 72 hours, and dramatically increased the quality and numbers of these organs transplanted. Furthermore, this solution appears effective for the preservation of the kidney for three days and the heart for at least 15 hours. 

First successful live-donor partial pancreas transplant 1998... 

The pancreas is a small retroperitoneal organ located behind the stomach on the posterior abdominal wall.1,3 The pancreas has both exocrine and endocrine functions. The exact nationwide prevalence of all diseases of the pancreas has not been fully quantified however, DM, both types 1 and 2, affect nearly 21 million people in the United States alone. Some reasons for pancreas transplants include ... 

Some people suffering from DM also may be afflicted with ESRD. A small percentage of these patients may undergo a simultaneous pancreas-kidney (SPK) transplant, which may be accomplished using organs from deceased or living donors. There were 541 pancreas transplants and 903 SPK procedures done in 2005.3... 

CMV disease For the prevention of CMV disease in kidney, heart, and kidney-pancreas transplant patients at high risk (Donor CMV seropositive/Recipient CMV seronegative [(D+/R-)]). 

The drugs like azathioprine and cyclosporine A are used chiefly to prevent transplant rejection and in the treatment of autoimmune diseases. They are used to prevent graft rejection after kidney, liver, lung, pancreas transplant or bone marrow transplantation. 

Recent data from a kidney pancreas induction study suggests that 2 doses of Daclizumab (2 mg/kg) at day 0 and day 14 is equivalent to 5 doses of 1 mg/kg every 14 days. (Stratta AJ, Alloway RR, Hodge E et al. A multicenter, open-label, comparative trial of two Daclizumab dosing strategies vs. no antibody induction in combination with tacrolimus, mycophenolate mofetil, and steroids for the prevention of acute rejection in simultaneous kidney-pancreas transplant recipients interim analysis. Clin Transplant 2002 l6(l) 60-8.)... 

Glyburide may be given after pancreas transplantation in patients with impaired glucose tolerance. 

After pancreas transplantation with bladder damage, up to 10 to 12 tablets per day are necessary to prevent metabolic acidosis. Monitor CO levels. 

Prospective, randomized trial did not show a benefit after pancreas transplantation. Octreotide lowers cyclosporine-A levels and may cause escape rejection if cyclosporine levels are not carefully monitored. Intravenous infusions of 25-50 mcg/hour have been utilized. 

Guessner RW, Kandaswamy R, Humar A, Gruessner AC, et al. 2005. Calcineurin inhibitor - and steroid free immune suppression in pancreas-kidney and solitary pancreas transplantation. Transplant. 79 1184-1189. 

There are many different procedures used for pancreas transplantation, and there is no one standard protocol used in all transplant centers. The important considerations, however, are that the arterial blood flow supply to the pancreas and duodenal segment, and venous outflow from the pancreas via the portal vein should be adequate. The recipient s right common or external iliac artery is used to restore vascularization of the artery in the pancreas. The Y graft of the tissue is anastomosed end-to-side and the venous vascularization is performed either systemically or portally, but mostly it is done with systemic venous drainage. 

Kaufman DB, A. 2006. Pancreas transplantation. Koffron www.emedicine.com/med/topic 2605.htm. 

A scientific registry of transplant recipients has been used to determine the effect of cadaveric organ donor treatment with desmopressin on the incidence of pancreas graft thrombosis in clinical pancreas transplantation (70). Of 2804 cases with sufficient information between 5 April 1994 and 27 September 2002, 1287 (46%) had received desmopressin. The mean follow up was 1.5 years (1 month to 8.4 years). There was pancreatic graft thrombosis in 4.3%, of whom 5.1% had received desmopressin and 3.5% had not this was just statistically significant. There was no information about dose, time-course, or duration of desmopressin use. It is not known whether this finding is clinically significant. 

Malaise J, Leonet J, Goffin E, Lefebvre C, Tennstedt D, Vandeleene B, Buysschaert M, Squifflet J. Pancreas transplantation for treatment of generalised allergy to human insulin in type I diabetes. Transplant Proc 2005 37 2839. 

Hricik DE. Kidney-pancreas transplantation for diabetic nephropathy. Semin Nephrol. 2000 20 188-198. 

Stegall MD, Larson TS, Kudva YC, et al. Pancreas transplantation for the prevention of diabetic nephropathy. Mayo Clin Proc. 2000 75 49-56. 

R. Thistlethwaite and K. S. Polonsky Oscillatory insulin secretion after pancreas transplant. Diabetes 1993, 42 855-861. 

Alemtuzumab (campath-lH) is a humanized monoclonal antibody specific for the CDw52 antigen, present on cell membranes of lymphocytes and monocytes. It has been used for treatment of patients with rheumatoid arthritis and vasculitis, is being investigated for the treatment of chronic lymphocytic leukemia, and has been used to deplete circulating lymphocytes in patients with multiple sclerosis (1). In 2001, alemtuzumab was approved in Europe for the treatment of chronic B cell lymphocytic leukemia that had been treated previously with alkylating agents and was refractory to fludarabine (2). It has also been used for induction of immunosuppression/tolerance in liver transplant recipients (3,4) and kidney/pancreas transplant recipients (5). 

A 29-year-old white woman with cadaveric kidney and pancreas transplants had two early rejection episodes but then stabilized on ciclosporin 100 mg bd and prednisolone 5 mg/day. Her blood ciclosporin concentration was consistently 200-350 ng/ml. She then started to take St. John s wort and over the next 30 days her blood ciclosporin concentration fell to 155 ng/ml and 3 weeks later to 97 ng/ml. Her serum creatinine rose to 1.3 mg/dl (115 pmol/l) and... 

A 29-year-old woman, who had received a cadaveric kidney and pancreas transplant, had stable organ function with ciclosporin when she decided to take St. John s wort (25). Subsequently her ciclosporin concentrations became subtherapeutic and she developed signs of organ rejection. St. John s wort was withdrawn and her ciclosporin concentrations returned to the target range. However, she developed chronic kidney rejection and had to return to dialysis. 

Gruessner RW, Sutherland DE, Drangstveit MB, WrenshaU L, Humar A, Gruessner AC. Mycophenolate mofetil in pancreas transplantation. Transplantation 1998 66(3) 318-23. 

A 38-year-old woman was switched from ciclosporin to tacrolimus 44 days after kidney and pancreas transplantation and 17 days later had sudden hearing loss with tinnitus. Her tacrolimus blood concentration 3 days later was 28 ng/ml and peaked at 35 ng/ml 8 days later. Audiograms showed bilateral hearing loss—80% for speech perception and mild to moderate sensorineural hearing loss. Her hearing improved on tacrolimus dosage reduction and after the tacrohmus blood concentration reached 15 ng/ml. 

Starzl TE,Todo S, Fung J, Demetris AJ,Venkataramman R, Jain A. FK 506 for liver, kidney, and pancreas transplantation. Lancet 1989 2 1000-1004. 

Young BA, Marsh CL, Alpers CE, Davis CL. Cyclosporine-associated thrombotic microangiopathy/hemolytic uremic syndrome following kidney and kidney-pancreas transplantation. Am J Kidney Dis 1996 28 561-571. 

Fioretto P, Steffes MW, Mihatsch MJ, Strom EFI, Sutherland DE, Mauer M. Cyclosporine associated lesions in native kidneys of diabetic pancreas transplant recipients. Kidney Int 1995 48 489-495. 

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