RESUMEN
INTRODUCTION: This study compared the safety and efficacy of University of Wisconsin solution (UW) and Celsior solution (C) in pancreas transplantation (PTx). METHODS: A retrospective review of 154 PTx performed over a 61-month period included 77 grafts preserved with UW and 77 with C. The two groups were comparable for both donor and recipient characteristics. RESULTS: After a mean cold ischemia time of 624 minutes (range 360 to 945 minutes) for UW versus 672 minutes (range 415 to 1005 minutes) for C (P = NS), no primary endocrine nonfunction occurred. Delayed endocrine function was diagnosed in two grafts in the UW group (2.6%) versus none in the C group (P = NS). After a minimum follow-up of 4 months (mean 26.5 +/- 15.2 months), 22 recipients (UW = 11 vs C = 11; P = NS) required relaparotomy. Overall, 18 pancreata were lost due to either patient death with functioning graft (UW = 4 vs C = 1; P = NS) or graft loss due to other reasons (UW = 8 vs C = 5; P = NS). Actuarial 1- and 5-year patient survival rates were 93.5% and 86.8% for UW compared with 98.7% and 98.7% for C (P = .04). Actuarial graft survival rates at the same times were 88.3% and 75.0% for UW compared with 90.4% and 90.4% for C (P = NS). CONCLUSIONS: Within the range of cold ischemia times reported in this study, UW and C show similar safety and efficacy profiles for PTx.
Asunto(s)
Soluciones Preservantes de Órganos , Trasplante de Páncreas/estadística & datos numéricos , Donantes de Tejidos/estadística & datos numéricos , Adenosina , Adulto , Alopurinol , Incompatibilidad de Grupos Sanguíneos , Cadáver , Causas de Muerte , Disacáridos , Electrólitos , Femenino , Glutamatos , Glutatión , Histidina , Humanos , Insulina , Italia , Masculino , Manitol , Complicaciones Posoperatorias , Rafinosa , Estudios Retrospectivos , Insuficiencia del TratamientoRESUMEN
AIMS: Portal-enteric drainage (PED) might be particularly suitable for pancreas transplantation alone (PTA), since it has been associated with an immunologic advantage and achieves excellent metabolic results. We describe our experience with a consecutive series of 40 PTAs with PED. METHODS: Between April 2001 and March 2004, 40 consecutive PTAs were performed with PED. Recipients were selected according to the American Diabetic Association recommendations. Donors were selected according to standard criteria irrespective of HLA match, although matching for A and B loci was considered at the time of graft allocation. Immunosuppression consisted of induction treatment with basiliximab (n = 34) or thymoglobulin (n = 6), and maintenance therapy with steroids, mycophenolate mofetil, and tacrolimus. RESULTS: After a mean cold ischemia time of 690 minutes (range, 517-965 min) all pancreases functioned immediately. Three grafts were lost due to hyperacute or accelerated rejection. No graft was lost to vascular thrombosis, although 5 (12.5%) nonocclusive thromboses were identified and the grafts were rescued with intravenous heparin infusion. A repeat laparotomy was required in 7 recipients (17.5%) No patient required multiple repeat laparotomies, and none died. After a mean follow-up of 16.4 months (range, 1-36 mo), 2 recipients were diagnosed with rejection episodes, which were reversed with steroid boluses. Actuarial 3-year patient, and graft survival rates were 100% and 94.9%, respectively. The following parameters showed significant improvement compared with pretransplantation evaluation: hemoglobin A1C concentration, total and high-density lipoprotein cholesterol levels, arterial blood pressure, cardiac performance, retinopathy, proteinuria, and neuropathy. CONCLUSIONS: Pancreas transplantation alone with PED provides high rates of long-term insulin-independence.
Asunto(s)
Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 1/cirugía , Insulina/uso terapéutico , Trasplante de Páncreas/métodos , Adulto , Nefropatías Diabéticas/epidemiología , Neuropatías Diabéticas/epidemiología , Retinopatía Diabética/epidemiología , Drenaje/métodos , Femenino , Humanos , Hipoglucemiantes/uso terapéutico , Masculino , Trasplante de Páncreas/fisiología , Selección de Paciente , Sistema Porta , Donantes de Tejidos , Resultado del TratamientoRESUMEN
BACKGROUND: Most solitary pancreas transplants (SPTx) fail due to unrecognized rejection episodes. Consequently, SPTx are monitored by drainage into the bladder or by surveillance biopsies. METHODS: Between April 2001 and June 2003, a consecutive series of 48 SPTx were performed using portal enteric drainage (PED). Rejection episodes were diagnosed empirically, based on the elevated pancreatic enzymes without a surveillance biopsy. Immunosuppression consisted of basiliximab (n = 42) or ATG (n = 6), low-dose steroids, MMF, and tacrolimus. Donors (mean age 28.9 year; range 9 to 54 year) were selected according to standard criteria irrespective of HLA match, although the best HLA matching was considered at the time of graft allocation. RESULTS: After a mean cold ischemia time of 676 minutes (range 475 to 900 minutes), all but two pancreata (95.8%) functioned immediately. Relaparotomy was required in seven cases (14.6%). Three grafts were lost in the early posttransplant period due to hyperacute rejection. Two additional grafts were lost later due to arterial thrombosis or to chronic rejection. After a median follow-up period of 12.2 months (range 0.2 to 27 months) three further recipients were diagnosed with rejection episodes that were reversed with steroid boluses. Actuarial 1-year patient and graft survival rates were 100% and 93.1% and 2-year figures 100% and 88.7%, respectively. At the longest follow-up no recipient was diagnosed with a malignancy. CONCLUSIONS: With current immunosuppression protocols SPTx achieves high rates of insulin independence even without surveillance biopsy or routine use of T-cell-depleting therapies.
Asunto(s)
Trasplante de Páncreas/métodos , Sistema Porta , Biopsia , Drenaje/métodos , Humanos , Trasplante de Páncreas/patología , Trasplante de Páncreas/fisiología , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Seguridad , Insuficiencia del Tratamiento , Resultado del TratamientoRESUMEN
BACKGROUND: Although the use of Celsior has been recently described for heart, lung, liver, and kidney transplantation, no data are available on its use for clinical pancreas preservation. METHODS: We herein describe the results of 112 pancreas transplants preserved with either University of Wisconsin (UW; (n = 56) or Celsior (n = 56) solution at two Italian transplant centers. The groups were comparable with regard to all donor and recipient characteristics. RESULTS: Mean cold and warm ischemia times were 10.1 +/- 2.2 hours and 37.2 +/- 8.2 minutes for UW compared to 10.8 +/- 2.4 hours and 38.3 +/- 6.7 minutes for Celsior (P = NS). Delayed endocrine pancreas function was recorded in two UW-preserved grafts (3.6%). Actuarial 1-year patient survival was 94.6% for UW as compared with 100% for Celsior (P = NS). Equivalent graft survival figures were 91.0% for UW as compared with 96.4% for Celsior (P = NS). CONCLUSIONS: Within the range of cold ischemia times reported in this study, UW and Celsior solutions have similar safety profiles for pancreas transplantation.
Asunto(s)
Adenosina , Alopurinol , Disacáridos , Electrólitos , Glutamatos , Glutatión , Histidina , Insulina , Manitol , Preservación de Órganos/métodos , Trasplante de Órganos/fisiología , Trasplante de Páncreas/fisiología , Páncreas , Rafinosa , Adulto , Glucemia/análisis , Femenino , Supervivencia de Injerto/fisiología , Prueba de Histocompatibilidad , Humanos , Isquemia , Italia , Masculino , Persona de Mediana Edad , Soluciones Preservantes de Órganos , Trasplante de Páncreas/mortalidad , Estudios Retrospectivos , Análisis de Supervivencia , Donantes de Tejidos/estadística & datos numéricosRESUMEN
BACKGROUND: Despite recent improvements, surgical complications continue to occur frequently after pancreas transplantation, remaining the leading cause of early graft loss. Small-bowel obstruction, however, is exceedingly rare; it has not been associated with an enhanced risk of graft loss. METHODS: Intestinal obstruction occurred 7 days after pancreas transplantation due to bezoar blockage at the level of the jejunojejunostomy of the Roux-en-Y loop, which had been constructed to drain the exocrine secretions of the pancreas graft. RESULTS: CT scan promptly identified the foreign body and greatly facilitated graft rescue before duodenal rupture or the development of graft pancreatitis. Nineteen months after repeat laparotomy the patient is alive with good pancreatic endocrine function. CONCLUSIONS: In cases of pancreas transplantation with enteric drainage, obstruction of the Roux-en-Y loop may create a totally sealed system that may lead to severe duodenal dilation and eventually to duodenal rupture or graft pancreatitis.