RESUMEN
BACKGROUND: The most common multiple-organ transplant is the simultaneous pancreas-kidney transplantation (SPK). It is usually offered to patients who have insulin-dependent diabetes mellitus and those with diabetic nephropathy and renal failure that has already been established. In this study we present the results of 15 years of SPK in a transplant hospital center in Paraná, Brazil, and evaluated survival, immunosuppression, and transplant-related problems. METHODS: This study was a retrospective analysis of 131 SPK transplants performed at the Angelina Caron Hospital between January 2001 and December 2015. RESULTS: The mean age of SPK recipients was 34 years, with slight a predominance of males (50.4%). Mean graft ischemia time was 11 hours. Exocrine drainage was predominantly vesical, but this approach was abandoned after 2011. As for immunosuppression, induction was performed with basiliximab or thymoglobulin and maintained with prednisone, mycophenolate mofetil, tacrolimus, and/or sirolimus. Patient survival increased from 68.1% in 2001 to 2005 to 77.6% in 2011 to 2015. Graft survival at the end of the period was 85.7% for kidney and 75.5% for pancreas. The main surgery-derived problems for pancreas and kidney was thrombosis (15% and 6%, respectively). The main clinical problems were rejection of the pancreas (18.3%) and urinary infection of the kidney (33.3%). The main cause of death was intra-abdominal sepsis (11.4%). CONCLUSION: There was an improvement in survival rates over the time frame observed, but it remains necessary to adopt measures to reduce transplant-derived problems, including review of the antibiotic therapy protocol and measures to avoid graft thrombosis.
Asunto(s)
Diabetes Mellitus Tipo 1/cirugía , Nefropatías Diabéticas/cirugía , Trasplante de Riñón/mortalidad , Trasplante de Páncreas/mortalidad , Adulto , Brasil , Terapia Combinada , Femenino , Supervivencia de Injerto , Humanos , Terapia de Inmunosupresión/métodos , Trasplante de Riñón/métodos , Masculino , Persona de Mediana Edad , Trasplante de Páncreas/métodos , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
After decades of controversy surrounding the therapeutic validity of pancreas transplantation, the procedure has become accepted as the preferred treatment for selected patients with type 1 diabetes mellitus. Between January 2001 and January 2008, 100 patients underwent pancreatic transplantation at our center: 88 simultaneous pancreas-kidney transplantation and 12 pancreas transplantations alone. Pancreas graft management of the exocrine drainage technique involved enteric drainage in 8 (all simultaneous pancreas-kidney) and the bladder in 92 cases. The recipient systemic venous system was used for the pancreas graft venous effluent in all cases. Our overall results have shown that the number of functioning pancreatic grafts was 64 of 100. Graft losses were: rejection (n = 8), venous thrombosis (n = 9), arterial thrombosis (n = 1), or surgical complications such as anastomotic leak (n = 3), perigraft infection (n = 10), pancreatitis of the graft (n = 5). Most cases of pancreatitis (80%) had preservation times exceeding 18 hours. Despite surgical and immunosuppressive complications, our impression was that pancreas transplantation was a highly effective therapy for diabetes mellitus. After 7 years of the program and 100 transplantations, we believe that there is a major role for transplantation in diabetes management.
Asunto(s)
Diabetes Mellitus Tipo 1/cirugía , Trasplante de Páncreas/estadística & datos numéricos , Adolescente , Adulto , Brasil , Cadáver , Niño , Nefropatías Diabéticas/cirugía , Humanos , Inmunosupresores/uso terapéutico , Trasplante de Riñón/inmunología , Trasplante de Riñón/estadística & datos numéricos , Persona de Mediana Edad , Trasplante de Páncreas/inmunología , Trasplante de Páncreas/métodos , Sistema de Registros , Estudios Retrospectivos , Tacrolimus/uso terapéutico , Donantes de Tejidos , Resultado del Tratamiento , Estados UnidosRESUMEN
Celsior solution (CS), which has recently become available, that might theoretically offer a new means for improving graft preservation quality. The present prospective, randomized study was designed to evaluate the efficacy of CS compared with University of Wisconsin (UW) for pancreas allografts. Between January 2001 and January 2007, 88 patients underwent pancreatic transplantation, including the last 30 consecutive simultaneous pancreas kidney patients who were randomly assigned to either CS or UW. There was no case of graft thrombosis in either group. There were 2 cases of pancreatitis in the UW group compared with 1 in the CS group. No case of primary nonfunction occurred in either group. There were 2 cases of early duodenal stump fistulae in the CS group that required transplantectomy, whereas this complication was not observed in the UW group. Relaparotomy in the UW group was required in 3 cases due to infection and treated by close drainage that which, progressed to fatal sepsis in 1 patient. In the UW group with 6 months of follow-up, there were 12 patients insulin free. In the CS group, 6 patients underwent relaparotomy, 3 for transplantectomy and the others for intra-abdominal infection, which was fatal in 2 cases. In the CS group with 6 months of follow-up, there were 10 patients insulin free. Two patients died with functioning grafts. These results provided indirect evidence that CS solution is at least as safe as UW to mitigate postreperfusion graft edema and pancreatitis, as well as graft thrombosis.
Asunto(s)
Trasplante de Riñón/fisiología , Soluciones Preservantes de Órganos , Trasplante de Páncreas/fisiología , Páncreas , Daño por Reperfusión/epidemiología , Adenosina , Adulto , Alopurinol , Diabetes Mellitus Tipo 1/cirugía , Nefropatías Diabéticas/cirugía , Disacáridos , Electrólitos , Femenino , Glutamatos , Glutatión , Histidina , Humanos , Insulina , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/métodos , Masculino , Manitol , Persona de Mediana Edad , Páncreas/efectos de los fármacos , Trasplante de Páncreas/efectos adversos , Trasplante de Páncreas/métodos , Rafinosa , Daño por Reperfusión/prevención & control , Seguridad , Adulto JovenRESUMEN
Significant early bleeding is one of the surgical complications following simultaneous pancreas-kidney transplantation that has historically shaped the procedure. The consequence, exploratory laparotomy, carries high morbidity levels and elevated costs for the health system. Angiographic intervention is already a common procedure for the treatment of late, but not early, vascular complications. We describe a case of an early vascular complication that was successfully treated with angiographic embolization in a to simultaneous pancreas-kidney transplant patient.
Asunto(s)
Abdomen/irrigación sanguínea , Diabetes Mellitus Tipo 1/cirugía , Embolización Terapéutica , Hemorragia/etiología , Hemorragia/terapia , Trasplante de Riñón/efectos adversos , Trasplante de Páncreas/efectos adversos , Adulto , Angiografía , Nefropatías Diabéticas/cirugía , Femenino , Hemorragia/diagnóstico por imagen , Humanos , Fallo Renal Crónico/cirugía , Resultado del TratamientoRESUMEN
UNLABELLED: A pancreas transplantation is the only therapy capable of returning a constant, physiological euglycemic state to diabetic patients. Considering the clinical controversies in the study of infection in diabetes and the recognized effect of insulin on the oxidative metabolism of glucose in phagocytes, the present study sought to evaluate the formation of intraphagocytic oxygen-free radicals in diabetic patients undergoing simultaneous pancreas kidney transplantation (SPK). METHODS: Twenty-five diabetic patients undergoing SPK were compared with 25 normal individuals. Evaluation of the oxidative metabolism of leukocytes was performed using the NBT test. RESULTS: The abnormality in the pretransplant counts (19.32%-28.2%) reached normal levels at 48 hours after transplantation (45.11%-76.25%) and was maintained to the 5th day (46.28%-76.20%). CONCLUSION: An SPK in a diabetic patient normalized the formation of intraphagocytic oxygen-free radicals.
Asunto(s)
Diabetes Mellitus/cirugía , Neutrófilos/fisiología , Trasplante de Páncreas/fisiología , Adulto , Diabetes Mellitus/sangre , Femenino , Humanos , Leucocitos/fisiología , Masculino , Consumo de Oxígeno , Fagocitos/fisiología , Periodo Posoperatorio , Cuidados Preoperatorios , Estudios RetrospectivosRESUMEN
Several pieces of evidence suggest an autoimmune etiology of diabetes mellitus type 1. To trace patients who are susceptible to the disease, we utilized islet cells antibodies (ICAs). The aim of this study was to evaluate the presence of ICAs among diabetic patients undergoing simultaneous transplantation of the pancreas and kidney (SPK). Twenty-six diabetic patients received an SPK, 12 of whom were included in this analysis. The indirect immunofluorescence method was utilized for quantitation of ICAs. The types of ICAs were no different following transplantation of the pancreas. The serum levels of pre-existent ICAS in diabetic patients undergoing SPK with immunosuppression were not reduced, and they did not interfere with the function of the implanted pancreas over a period of 60 days.
Asunto(s)
Autoanticuerpos/sangre , Diabetes Mellitus/inmunología , Diabetes Mellitus/cirugía , Islotes Pancreáticos/inmunología , Trasplante de Páncreas , Adulto , Análisis de Varianza , Glucemia/metabolismo , Diabetes Mellitus/sangre , Femenino , Humanos , Terapia de Inmunosupresión/métodos , MasculinoRESUMEN
Most pancreas transplant centers initially use immunosuppression with antilymphocyte induction because the pancreas appears to be a highly immunogeneic organ. Although the addition of an antilymphocyte agent provides enhanced immunosuppression in the early posttransplant period, it is associated with added costs and adverse reactions. In this study we evaluated the safety and efficacy of tacrolimus (Tac), mycophenolate mofetil (MMF), and steroid immunosuppression without induction after simultaneous kidney-pancreas transplantation (SKPT). Six patients (30%) displayed rejection episodes with a mean follow-up of 12 months (range = 4 to 18 months). No graft was lost due to rejection. The results of this series suggest that SKPT can be safely performed without induction therapy.