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Transplant options for patients undergoing total pancreatectomy for chronic pancreatitis.
- Source :
-
Journal of the American College of Surgeons [J Am Coll Surg] 2004 Apr; Vol. 198 (4), pp. 559-67; discussion 568-9. - Publication Year :
- 2004
-
Abstract
- Background: Total pancreatectomy to treat chronic pancreatitis is associated with severe diabetic control problems in 15% to 75% of patients, causing up to 50% of deaths late postoperatively. We report our experience with islet autotransplants at the time of, or with pancreas allotransplants after, total pancreatectomy.<br />Study Design: Between February 1, 1977, and June 30, 2003, we performed 112 islet autotransplants at the time of total pancreatectomy; we also performed 20 pancreas allotransplants in 13 patients who had already undergone total pancreatectomy months to years earlier.<br />Results: Islet autotransplants at the time of total pancreatectomy in patients who had not had previous operations on the body and tail of the pancreas were associated with a high islet yield (>2,500 islet equivalents/kg body weight), and >70% of the recipients achieved complete insulin independence. In contrast, a previous distal pancreatectomy or a Puestow drainage procedure was associated with a low islet yield in 75% of them and with complete insulin independence in <20%. A pancreas allotransplant after total pancreatectomy was not associated with any transplant-related mortality at 1 and 3 years posttransplant. The pancreas graft survival rate at 1 year posttransplant was 77% with tacrolimus-based immunosuppression (versus 67% with cyclosporine). Enteric (over bladder) drainage was preferred to manage exocrine graft secretions, to cure pancreatectomy-induced endocrine and exocrine insufficiency.<br />Conclusions: Our series shows that pancreas allotransplants can be performed without transplant-related mortality and, when tacrolimus-based immunosuppression is used, with 1-year pancreas graft survival rates >75%. In contrast to a simultaneous islet autotransplant, a pancreas allotransplant has the disadvantage of requiring lifelong immunosuppression, but the advantage of not only curing endocrine but also exocrine insufficiency. Both transplant options, if successful, improve the recipient's quality of life.
- Subjects :
- Adolescent
Adult
Child
Chronic Disease
Diabetes Mellitus etiology
Diabetes Mellitus surgery
Exocrine Pancreatic Insufficiency etiology
Exocrine Pancreatic Insufficiency surgery
Female
Humans
Male
Middle Aged
Pancreatectomy methods
Treatment Outcome
Islets of Langerhans Transplantation methods
Pancreas Transplantation methods
Pancreatectomy adverse effects
Pancreatitis surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1072-7515
- Volume :
- 198
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of the American College of Surgeons
- Publication Type :
- Academic Journal
- Accession number :
- 15051008
- Full Text :
- https://doi.org/10.1016/j.jamcollsurg.2003.11.024