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Ventura-Aguiar P, Cabello M, Beneyto I, Navarro Cabello D, Tabernero G, Alonso A, Ruiz JC, Llorente S. Patient and graft survival in pancreas transplant recipients: The EFISPAN study. Nefrologia 2023; 43:133-143. [PMID: 36494288 DOI: 10.1016/j.nefroe.2022.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/15/2021] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Graft outcomes in pancreas transplantation have improved in recent decades, but data are mainly derived from registries or prospective single-centre studies. This large epidemiological study was undertaken to investigate the impact of clinical and demographic factors on graft and patient survival in pancreas transplant recipients in Spain, and to provide robust, country-wide, practice-based data to complement registry findings. PATIENTS AND METHODS We conducted a retrospective, longitudinal, epidemiological study to assess risk factors impacting patient and graft survival in pancreas transplant recipients in eight centres in Spain. All patients transplanted between 1 January 2008 and 31 December 2012 were included; data were collected until 31 December 2015. The Kaplan-Meier method was used for all time-to-event analyses, including patient survival, graft survival, acute rejection, and BPAR. For graft survival analysis, in cases of death with functioning graft, patients were censored without any event on the date of death. For acute rejection and BPAR, patients were censored without any event on the date of death or graft loss. Univariable and multivariable analyses (Cox proportional hazards model) were conducted to assess the association between baseline clinical and demographic characteristics and patient/graft survival. RESULTS Data were included for 241 (80.1%) simultaneous pancreas-kidney transplants, 56 (18.6%) pancreas-after-kidney transplants and 4 (1.3%) pancreas transplants alone. Mean±standard deviation time from diagnosis until transplantation was 26.1±7.5 years. Nineteen patients died, mainly due to infections (n=10); the remaining 282 patients (93.7%) survived from transplantation until the end of the study. Among 55 patients (18.3%) with pancreas graft loss, the main reasons were vascular thrombosis (n=19), chronic rejection (n=10), acute rejection (n=6) and death with a functioning graft (n=5). The overall rate of vascular-related death was 1.3% at 5 years post transplant. Univariable analysis showed that patient age and weight, donor age, previous kidney transplantation, previous cardiovascular events and need for insulin more than 48h post transplantation were significantly associated with pancreas graft survival. Of these, in multivariable analyses pancreas graft survival was inferior in patients who had received a previous kidney transplant prior to pancreas transplantation (log-rank test, p=0.0002). Glucose metabolism, renal function and cardiovascular risk factors were generally stable following transplantation. CONCLUSIONS The results of this multicentre study highlight the excellent patient and graft outcomes following pancreas transplantation, with a notably low incidence of cardiovascular events.
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Affiliation(s)
- Pedro Ventura-Aguiar
- Department of Nephrology and Kidney Transplantation, Hospital Clinic, Barcelona, Spain.
| | - Mercedes Cabello
- Department of Nephrology, Hospital Regional Universitario de Malaga, Málaga, Spain
| | - Isabel Beneyto
- Department of Nephrology, Hospital La Fe, Valencia, Spain
| | | | - Guadalupe Tabernero
- Department of Nephrology, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Angel Alonso
- Department of Nephrology, Hospital Universitario de A Coruña, A Coruña, Spain
| | - Juan Carlos Ruiz
- Department of Nephrology, Hospital Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain
| | - Santiago Llorente
- Department of Nephrology, Hospital Virgen de la Arrixaca, Murcia, Spain
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Ventura-Aguiar P, Cabello M, Beneyto I, Navarro Cabello D, Tabernero G, Alonso A, Ruiz JC, Llorente S. Patient and graft survival in pancreas transplant recipients: The EFISPAN study. Nefrologia 2021. [DOI: 10.1016/j.nefro.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Argente-Pla M, Martínez-Millana A, Espí-Reig J, Maupoey-Ibáñez J, Moya-Herráiz Á, Beneyto-Castello I, López-Andújar R, Merino-Torres JF. Results after 13 years of kidney-pancreas transplantation in type 1 diabetic patients in Comunidad Valenciana. Cir Esp 2021; 99:666-677. [PMID: 34674986 DOI: 10.1016/j.cireng.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Simultaneous pancreas-kidney (SPK) transplant is a proven option of treatment for patients with type 1 diabetes mellitus and related end-stage renal disease, who are candidates for kidney transplantation. The results from the beginning of SPK transplant program in Comunidad Valenciana are presented. METHODS Descriptive, retrospective, and single-center study of the pancreas transplant performed at the Hospital Universitari i Politècnic La Fe, from September 2002 to December 2015. Clinical variables from donors and recipients, peri-operative variables, patient survival, and pancreatic graft survival were collected. RESULTS Eighty-one patients with type 1 diabetes mellitus (48 males and 33 females, mean age 37.4 ± 5.7 years, mean BMI 24.1 ± 3.4 kg/m2, mean duration of diabetes 25.5 ± 6.5 years) received SPK transplantation. The overall patient survival at one, 3, and 5 years were 91.3%, 91.3% and 89.5%, respectively. However, patient survival in the periods 2002-2008 and 2009-2015 were 88.2% and 93.6% at one year, 88.2% and 93.7% at 3 years, and 85.3% and 93.7% at 5 years, respectively (P = 1). The overall pancreatic graft survival at one, 3, and 5 years were 75.2%, 69.1% and 63.2%, respectively. On the other hand, pancreatic graft survival in the periods 2002-2008 and 2009-2015 were 67.5% and 80.6% at one year, 64.7% and 71.8% at 3 years, and 58.8% and 65.3% at 5 years, respectively (P = .0109). Post-transplant complications were: graft rejection 8.6%, venous graft thrombosis 7.4%, graft pancreatitis 4.9%. CONCLUSIONS In 13 years' experience of SPK transplantation, patient and pancreatic graft survival and the rate of complications after pancreas transplantation were similar to those of other larger series. The medical-surgical team experience improves pancreatic graft survival without influencing patient survival.
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Affiliation(s)
- María Argente-Pla
- Servicio de Endocrinología y Nutrición, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Unidad Mixta de Investigación en Endocrinología, Nutrición y Dietética, Instituto de Investigación La Fe, Valencia, Spain.
| | | | - Jordi Espí-Reig
- Servicio de Nefrología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Javier Maupoey-Ibáñez
- Unidad de Cirugía Hepato-Bilio-Pancreática y Unidad de Trasplante, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ángel Moya-Herráiz
- Unidad de Cirugía Hepato-Bilio-Pancreática y Unidad de Trasplante, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Rafael López-Andújar
- Unidad de Cirugía Hepato-Bilio-Pancreática y Unidad de Trasplante, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Juan Francisco Merino-Torres
- Servicio de Endocrinología y Nutrición, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Unidad Mixta de Investigación en Endocrinología, Nutrición y Dietética, Instituto de Investigación La Fe, Valencia, Spain; Departament de Medicina, Universitat de València, Valencia, Spain
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4
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Ferrer-Fàbrega J, Fernández-Cruz L. Exocrine drainage in pancreas transplantation: Complications and management. World J Transplant 2020; 10:392-403. [PMID: 33437672 PMCID: PMC7769732 DOI: 10.5500/wjt.v10.i12.392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/23/2020] [Accepted: 12/08/2020] [Indexed: 02/06/2023] Open
Abstract
The aim of this minireview is to compare various pancreas transplantation exocrine drainage techniques i.e., bladder vs enteric. Both techniques have different difficulties and complications. Numerous comparisons have been made in the literature between exocrine drainage techniques throughout the history of pancreas transplantation, detailing complications and their impact on graft and patient survival. Specific emphasis has been made on the early postoperative management of these complications and the related surgical infections and their consequences. In light of the results, a number of bladder-drained pancreas grafts required conversion to enteric drainage. As a result of technical improvements, outcomes of the varied enteric exocrine drainage techniques (duodenojejunostomy, duodenoduodenostomy or gastric drainage) have also been discussed i.e., assessing specific risks vs benefits. Pancreatic exocrine secretions can be drained to the urinary or intestinal tracts. Until the late 1990s the bladder drainage technique was used in the majority of transplant centers due to ease of monitoring urine amylase and lipase levels for evaluation of possible rejection. Moreover, bladder drainage was associated at that time with fewer surgical complications, which in contrast to enteric drainage, could be managed with conservative therapies. Nowadays, the most commonly used technique for proper driving of exocrine pancreatic secretions is enteric drainage due to the high rate of urological and metabolic complications associated with bladder drainage. Of note, 10% to 40% of bladder-drained pancreata eventually required enteric conversion at no detriment to overall graft survival. Various surgical techniques were originally described using the small bowel for enteric anastomosis with Roux-en-Y loop or a direct side-to-side anastomosis. Despite the improvements in surgery, enteric drainage complication rates ranging from 2%-20% have been reported. Treatment depends on the presence of any associated complications and the condition of the patient. Intra-abdominal infection represents a potentially very serious problem. Up to 30% of deep wound infections are associated with an anastomotic leak. They can lead not only to high rates of graft loss, but also to substantial mortality. New modifications of established techniques are being developed, such as gastric or duodenal exocrine drainage. Duodenoduodenostomy is an interesting option, in which the pancreas is placed behind the right colon and is oriented cephalad. The main concern of this technique is the challenge of repairing the native duodenum when allograft pancreatectomy is necessary. Identification and prevention of technical failure remains the main objective for pancreas transplantation surgeons. In conclusion, despite numerous techniques to minimize exocrine pancreatic drainage complications e.g., leakage and infection, no universal technique has been standardized. A prospective study/registry analysis may resolve this.
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Affiliation(s)
- Joana Ferrer-Fàbrega
- HepatoBiliaryPancreatic Surgery and Liver and Pancreas Transplantation Department, ICMDM, Hospital Clinic Barcelona, University of Barcelona, Barcelona Clinic Liver Cancer Group, August Pi i Sunyer Biomedical Research Institute, Barcelona 08036, Barcelona, Spain
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Daga JAP, Rodriguez RP, Santoyo J. Immediate post-operative complications (I): Post-operative bleeding; vascular origin: Thrombosis pancreatitis. World J Transplant 2020; 10:415-421. [PMID: 33437674 PMCID: PMC7769729 DOI: 10.5500/wjt.v10.i12.415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/17/2020] [Accepted: 12/17/2020] [Indexed: 02/05/2023] Open
Abstract
Simultaneous pancreas-kidney transplantation is the treatment of choice for insulin-dependent diabetes that associates end-stage diabetic nephropathy, since it achieves not only a clear improvement in the quality of life, but also provides a long-term survival advantage over isolated kidney transplant. However, pancreas transplantation still has the highest rate of surgical complications among organ transplants. More than 70% of early graft losses are attributed to technical failures, that is, to a non-immunological cause. The so-called technical failures include graft thrombosis, bleeding, infection, pancreatitis, anastomotic leak and pancreatic fistula. Pancreatic graft thrombosis leads these technical complications as the most frequent cause of early graft loss. Currently most recipients receive postoperative anticoagulation with the aim of reducing the rate of thrombosis. Hemoperitoneum in the early postoperative period is a frequent cause of relaparotomy, but it is not usually associated with graft loss. The incidence of hemoperitoneum is clearly related to the use of anticoagulation in the postoperative period. Post-transplant pancreatitis is another cause of early postoperative complications, less frequent than the previous. In this review, we analyze the most common surgical complications that determine pancreatic graft losses.
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Affiliation(s)
| | | | - Julio Santoyo
- Department of Surgery, Hospital Regional de Málaga, Malaga 29010, Spain
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Argente-Pla M, Martínez-Millana A, Espí-Reig J, Maupoey-Ibáñez J, Moya-Herráiz Á, Beneyto-Castello I, López-Andújar R, Merino-Torres JF. Results after 13 years of kidney-pancreas transplantation in type 1 diabetic patients in Comunidad Valenciana. Cir Esp 2020; 99:S0009-739X(20)30312-2. [PMID: 33341241 DOI: 10.1016/j.ciresp.2020.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/15/2020] [Accepted: 09/23/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Simultaneous pancreas-kidney (SPK) transplant is a proven option of treatment for patients with type 1 diabetes mellitus and related end-stage renal disease, who are candidates for kidney transplantation. The results from the beginning of SPK transplant program in Comunidad Valenciana are presented. METHODS Descriptive, retrospective, and single-center study of the pancreas transplant performed at the Hospital Universitari i Politècnic La Fe, from September 2002 to December 2015. Clinical variables from donors and recipients, peri-operative variables, patient survival, and pancreatic graft survival were collected. RESULTS Eighty-one patients with type 1 diabetes mellitus (48 males and 33 females, mean age 37.4±5.7 years, mean BMI 24.1±3.4kg/m2, mean duration of diabetes 25.5±6.5 years) received SPK transplantation. The overall patient survival at one, 3, and 5 years were 91,3, 91,3 and 89,5%, respectively. However, patient survival in the periods 2002-2008 and 2009-2015 were 88.2 and 93.6% at one year, 88.2 and 93.7% at 3 years, and 85.3 and 93.7% at 5 years, respectively (P=1). The overall pancreatic graft survival at one, 3, and 5 years were 75.2, 69.1 and 63.2%, respectively. On the other hand, pancreatic graft survival in the periods 2002-2008 and 2009-2015 were 67.5 and 80.6% at one year, 64.7 and 71.8% at 3 years, and 58.8% and 65.3% at 5 years, respectively (P=.0109). Postransplant complications were: graft rejection 8.6%, venous graft thrombosis 7.4%, graft pancreatitis 4.9%. CONCLUSIONS In 13-year's experience of SPK transplantation, patient and pancreatic graft survival and the rate of complications after pancreas transplantation were similar to those of other larger series. The medical-surgical team experience improves pancreatic graft survival without influencing patient survival.
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Affiliation(s)
- María Argente-Pla
- Servicio de Endocrinología y Nutrición, Hospital Universitario y Politécnico La Fe, Valencia, España; Unidad Mixta de Investigación en Endocrinología, Nutrición y Dietética, Instituto de Investigación La Fe, Valencia, España.
| | | | - Jordi Espí-Reig
- Servicio de Nefrología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Javier Maupoey-Ibáñez
- Unidad de Cirugía Hepato-Bilio-Pancreática y Unidad de Trasplante, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Ángel Moya-Herráiz
- Unidad de Cirugía Hepato-Bilio-Pancreática y Unidad de Trasplante, Hospital Universitario y Politécnico La Fe, Valencia, España; CIBERehd, Instituto de Salud Carlos III, Madrid, España
| | | | - Rafael López-Andújar
- Unidad de Cirugía Hepato-Bilio-Pancreática y Unidad de Trasplante, Hospital Universitario y Politécnico La Fe, Valencia, España; CIBERehd, Instituto de Salud Carlos III, Madrid, España
| | - Juan Francisco Merino-Torres
- Servicio de Endocrinología y Nutrición, Hospital Universitario y Politécnico La Fe, Valencia, España; Unidad Mixta de Investigación en Endocrinología, Nutrición y Dietética, Instituto de Investigación La Fe, Valencia, España; Departament de Medicina, Universitat de València, Valencia, España
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7
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Ferrer-Fàbrega J, Cano-Vargas B, Ventura-Aguiar P, Cárdenas G, García-Criado Á, López-Boado MA, Rull R, García R, Cuatrecasas M, Esmatjes E, Diekmann F, Fondevila C, Ricart MJ, Fernández-Cruz L, Fuster J, García-Valdecasas JC. Early intestinal complications following pancreas transplantation: lessons learned from over 300 cases - a retrospective single-center study. Transpl Int 2020; 34:139-152. [PMID: 33084117 DOI: 10.1111/tri.13775] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/27/2020] [Accepted: 10/16/2020] [Indexed: 01/15/2023]
Abstract
Enteric complications remain a major cause of morbidity in the post-transplant period of pancreas transplantation despite improvements surgical technique. The aim of this single-center study was to analyze retrospectively the early intestinal complications and their potential relation with vascular events. From 2000 to 2016, 337 pancreas transplants were performed with systemic venous drainage. For exocrine secretion, intestinal drainage was done with hand-sewn anastomosis duodenojejunostomy. Twenty-three patients (6.8%) had early intestinal complications. Median age was 39 years (male: 65.2%). Median cold ischemia time was 11 h [IQR: 9-12.4]. Intestinal complications were intestinal obstruction (n = 7); paralytic ileus (n = 5); intestinal fistula without anastomotic dehiscence (n = 3); ischemic graft duodenum (n = 3); dehiscence of duodenojejunostomy (n = 4); and anastomotic dehiscence in jejunum after pancreas transplantectomy (n = 1). Eighteen cases required relaparotomy: adhesiolysis (n = 6); repeated laparotomy without findings (n = 1); transplantectomy (n = 6); primary leak closure (n = 3); re-positioning of the graft (n = 1); and intestinal resection (n = 1). Of the intestinal complications, 4 were associated with vascular thrombosis, resulting in two pancreatic graft losses. Enteric drainage with duodenum-jejunum anastomosis is safe and feasible, with a low rate of intra-abdominal complications. Vascular thrombosis associated with intestinal complications presents a risk factor for the viability of pancreatic grafts, so prevention and early detection is vital.
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Affiliation(s)
- Joana Ferrer-Fàbrega
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Clínic of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Brenda Cano-Vargas
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Clínic of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Pedro Ventura-Aguiar
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Renal Transplant Unit, Nephrology and Kidney Transplant Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Gabriel Cárdenas
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Clínic of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | - Miguel Angel López-Boado
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Clínic of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ramón Rull
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Clínic of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Rocío García
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Clínic of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Miriam Cuatrecasas
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Department of Pathology, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Network for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Barcelona, Spain
| | - Enric Esmatjes
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Diabetes Unit, Department of Endocrinology and Nutrition, Institute Clínic of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Fritz Diekmann
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Renal Transplant Unit, Nephrology and Kidney Transplant Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Constantino Fondevila
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Clínic of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Network for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Barcelona, Spain
| | - Mª José Ricart
- Renal Transplant Unit, Nephrology and Kidney Transplant Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Laureano Fernández-Cruz
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Clínic of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Josep Fuster
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Clínic of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Network for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Barcelona, Spain
| | - Juan Carlos García-Valdecasas
- Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Clínic of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Network for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Barcelona, Spain
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Pinchuk AV, Dmitriev IV, Anisimov YA, Storozhev RV, Balkarov AG, Kondrashkin AS, Khodilina IV, Muslimov RS. Pancreas transplantation with isolated splenic artery blood supply - Single center experience. Asian J Surg 2019; 43:315-321. [PMID: 31301933 DOI: 10.1016/j.asjsur.2019.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/13/2019] [Accepted: 06/25/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The blood supply of the native pancreas by three arterial lines from the celiac trunk system (splenic artery and common hepatic artery) and the superior mesenteric artery forces surgeons to perform vascular reconstruction to provide sufficient intra-organ blood flow into the graft. The purpose of our study was to assess the possibility of pancreas transplantation with an isolated splenic artery blood supply. METHODS From January 2012 to July 2018, simultaneous pancreas-kidney transplantation (SPKT) was performed in 21 patients. Gender: male - 11 (52,4%), female 10 (47,6%). Recipients aged 26 to 54, the median age was 38 [34; 42] years. In 6 (28,6%) recipients, the organ perfusion was carried out through the splenic artery alone; in the rest, it was performed through the splenic and inferior pancreaticoduodenal artery exiting from the superior mesenteric artery of the graft. The transplant function, the quality of carbohydrate metabolism compensation, the objective characteristics of intra-organ blood flow was assessed. RESULTS There were no statistically significant differences in the volume blood flow characteristics revealed by CT-perfusion and laboratory data in the study groups. CONCLUSIONS Based on the assessment of the function and quality of blood supply to the transplant, the possibility of performing pancreas transplantation with an isolated splenic artery blood supply had been proved.
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Affiliation(s)
- Alexey V Pinchuk
- N.V.Sclifosovsky Research Institute for Emergency Medicine, Kidney and Pancreas Transplantation Department, Moscow, Russia; Moscow State University of Medicine and Dentistry, Department of Transplantation and Artificial Organs, Moscow, Russia; Scientific Research Institute of Healthcare Organization and Medical Management, Moscow, Russia.
| | - Ilya V Dmitriev
- N.V.Sclifosovsky Research Institute for Emergency Medicine, Kidney and Pancreas Transplantation Department, Moscow, Russia
| | - Yuriy A Anisimov
- N.V.Sclifosovsky Research Institute for Emergency Medicine, Kidney and Pancreas Transplantation Department, Moscow, Russia.
| | - Roman V Storozhev
- N.V.Sclifosovsky Research Institute for Emergency Medicine, Kidney and Pancreas Transplantation Department, Moscow, Russia
| | - Aslan G Balkarov
- N.V.Sclifosovsky Research Institute for Emergency Medicine, Kidney and Pancreas Transplantation Department, Moscow, Russia
| | - Aleksandr S Kondrashkin
- N.V.Sclifosovsky Research Institute for Emergency Medicine, Kidney and Pancreas Transplantation Department, Moscow, Russia
| | - Irina V Khodilina
- N.V.Sclifosovsky Research Institute for Emergency Medicine, Department of Ultrasound Diagnostics, Moscow, Russia
| | - Rustam Sh Muslimov
- N.V.Sclifosovsky Research Institute for Emergency Medicine, Department of Emergency Radiology, Moscow, Russia
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Pinchuk AV, Anisimov IA, Dmitriev IV, Storozhev RV, Balkarov AG, Muslimov RS, Khodilina IV. [Pancreas transplantation with isolated blood supply through the splenic artery]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2019; 25:125-129. [PMID: 30994618 DOI: 10.33529/angio2019117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In multiple organ procurement, taking into consideration certain peculiarities of the vascular architectonics of the celiac trunk or an iatrogenic injury to the superior mesenteric artery, it is impossible to perform standard arterial reconstruction of a pancreas transplant with the use of a Y-shaped vascular allograft. This results in refusal from transplanting a potentially suitable organ. The purpose of our study was to assess the possibility of transplantation of the pancreatoduodenal complex with isolated blood supply via the splenic artery. Between January 2008 and November 2016, transplantation of the pancreas was carried out in a total of 20 patients (9 men and 11 women aged from 26 to 40 years, mean age 37.2±5.6 years). Depending on the number of the major arteries supplying the pancreas, the patients were divided into 2 groups. No statistically significant between-group differences in the parameters of volumetric blood flow determined by means of CT perfusion, in the majority of laboratory findings or therapeutic outcomes were revealed. Based on assessment of the function and quality of pancreatic blood supply, we proved feasibility of transplantation of the pancreatoduodenal complex with isolated blood supply through the splenic artery.
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Affiliation(s)
- A V Pinchuk
- Department of Kidney and Pancreas Transplantation, Research Institute of Emergency Medicine named after N.V. Sklifosovsky under the Moscow Health Care Department, Moscow, Russia
| | - Iu A Anisimov
- Department of Kidney and Pancreas Transplantation, Research Institute of Emergency Medicine named after N.V. Sklifosovsky under the Moscow Health Care Department, Moscow, Russia
| | - I V Dmitriev
- Department of Kidney and Pancreas Transplantation, Research Institute of Emergency Medicine named after N.V. Sklifosovsky under the Moscow Health Care Department, Moscow, Russia
| | - R V Storozhev
- Department of Kidney and Pancreas Transplantation, Research Institute of Emergency Medicine named after N.V. Sklifosovsky under the Moscow Health Care Department, Moscow, Russia
| | - A G Balkarov
- Department of Kidney and Pancreas Transplantation, Research Institute of Emergency Medicine named after N.V. Sklifosovsky under the Moscow Health Care Department, Moscow, Russia
| | - R Sh Muslimov
- Department of Radiodiagnosis, Research Institute of Emergency Medicine named after N.V. Sklifosovsky under the Moscow Health Care Department, Moscow, Russia
| | - I V Khodilina
- Department of Ultrasound Methods of Diagnosis, Research Institute of Emergency Medicine named after N.V. Sklifosovsky under the Moscow Health Care Department, Moscow, Russia
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Pinchuk AV, Dmitriev IV, Storozhev RV, Balkarov AG, Anisimov YA, Kondrashkin AS. [Pancreas transplantation followed by stumpless duodenal exocrine drainage]. Khirurgiia (Mosk) 2019:89-95. [PMID: 30855597 DOI: 10.17116/hirurgia201902189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pancreas transplantation followed by stumpless duodenal exocrine drainage was performed in 2 patients. Primary kidney and pancreas graft function was noted in both cases. Two procedures of pancreas transplantation followed by stumpless duodenal exocrine drainage were carried out for the first time. Perhaps, absent donor duodenal stump has several advantages for the further course of postoperative period that may be confirmed in prospective trials.
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Affiliation(s)
- A V Pinchuk
- Department of Pancreas and Kidney Transplantation of Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - I V Dmitriev
- Department of Pancreas and Kidney Transplantation of Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - R V Storozhev
- Department of Pancreas and Kidney Transplantation of Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - A G Balkarov
- Department of Pancreas and Kidney Transplantation of Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - Yu A Anisimov
- Department of Pancreas and Kidney Transplantation of Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - A S Kondrashkin
- Department of Pancreas and Kidney Transplantation of Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
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Retroperitoneal Pancreas Transplantation With the Use of Duodenal Drainage via "Button Technique": First Clinical Practice (Case Report). Transplant Proc 2018; 49:2347-2351. [PMID: 29198675 DOI: 10.1016/j.transproceed.2017.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The persistent relative high incidence of duodenum-associated surgical complications significantly reduces pancreas grafts' (PG) and recipients' survival rates. A 31-year-old female patient underwent retroperitoneal pancreas transplantation with the use of PG exocrine drainage into the recipient's duodenum via the "button technique" approach. An uncomplicated postoperative period with satisfactory function of both transplants (pancreas and kidney) was noted. This was the 1st time ever that the transplantation was performed with the use of retroperitoneal placement of the pancreas transplant and duodenal drainage via the "button technique" approach. It is possible that the absence of the duodenal stump in the donor's transplant has a number of benefits in the postoperative period, which can be confirmed during the follow-up observations.
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12
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Techniques of pancreas graft salvage/indications for allograft pancreatectomy. Curr Opin Organ Transplant 2017; 21:405-11. [PMID: 27058314 DOI: 10.1097/mot.0000000000000318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Despite improvements in pancreas allograft outcome, graft complications remain a significant cause of morbidity and mortality. This review analyses the issues involved in the management of conditions that may require graft pancreatectomy, including the indications and techniques for graft salvage. RECENT FINDINGS With early recognition of graft complications, liberal use of radiological interventions, improved infection control, access to critical care and innovative surgical techniques, graft salvage is now feasible in many circumstances where graft pancreatectomy would previously have been necessary. SUMMARY The outcome of pancreas transplantation continues to improve with advances in the management of graft-threatening complications.
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Casanova D. Pancreas transplantation: 50 years of experience. Cir Esp 2017; 95:254-260. [PMID: 28595751 DOI: 10.1016/j.ciresp.2017.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 02/21/2017] [Indexed: 12/27/2022]
Abstract
In December 1966, the first pancreas transplant ever was performed at the University of Minnesota. R. Lillehei and W. Kelly, transplanted a kidney and a pancreas in a diabetic patient on dialysis, getting function of both organs. Since then, the technical and immunological advances in this transplant have resulted in graft and patient survival results as the rest of the abdominal solid organ transplants. The balance of these 50 years is that more than 50,000 diabetic patients have been transplanted in more than 200 centers around the world. In our country the first transplant was performed 34 years ago in Barcelona and now 12 centers perform about 100 transplants per year. Although advances in diabetes control have been very important, pancreas transplantation continues to be the only method that allows normalization of the carbohydrates metabolism to improve the quality of life and, above all, to increase the survival of these patients.
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Affiliation(s)
- Daniel Casanova
- Chairman Board Europeo de Trasplante, Servicio de Cirugía General y Digestiva Hospital Universitario Marqués de Valdecilla, Santander, España.
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- Chairman Board Europeo de Trasplante, Servicio de Cirugía General y Digestiva Hospital Universitario Marqués de Valdecilla, Santander, España
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