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Generette GS, Bachul PJ, Golab K, Basto L, Pyda JS, Borek P, Tibudan M, Anteby R, Perea L, Charlton M, Perez-Gutierrez A, Jayant K, Lucander A, Matthews JB, Millis JM, Fung J, Witkowski P. En bloc liver and pancreas transplantation after total pancreatectomy with autologous islet transplantation. ACTA ACUST UNITED AC 2020; 3:11-17. [PMID: 33409500 PMCID: PMC7785098 DOI: 10.31373/ejtcm/130187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present a patient with intractable and debilitating pain secondary to chronic pancreatitis who was effectively treated with total pancreatectomy with islet autotransplantation (TPIAT). Islets engrafted into his liver significantly contributed to improved blood glucose control and quality of life. Subsequently, the patient developed alcohol related acute liver failure and en bloc liver and pancreas transplantation was performed to replace the failing liver with engrafted islets. Pancreas transplantation was required to resolve his life-threatening severe hypoglycemic episodes. Herein, we detail an innovative and multidisciplinary management of this complex medical problem.
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Affiliation(s)
| | - Piotr J Bachul
- The Transplantation Institute, University of Chicago, USA
| | - Karolina Golab
- The Transplantation Institute, University of Chicago, USA
| | - Lindsay Basto
- The Transplantation Institute, University of Chicago, USA
| | - Jordan S Pyda
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, USA
| | - Peter Borek
- The Transplantation Institute, University of Chicago, USA
| | - Martin Tibudan
- The Transplantation Institute, University of Chicago, USA
| | - Roi Anteby
- The Transplantation Institute, University of Chicago, USA
| | | | | | | | - Kumar Jayant
- The Transplantation Institute, University of Chicago, USA
| | - Aaron Lucander
- The Transplantation Institute, University of Chicago, USA
| | | | | | - John Fung
- The Transplantation Institute, University of Chicago, USA
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2
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Li C, Zhang W, Zhao Q, Ye M, Ju W, Wu L, Ma Y, Hu A, Wang G, Zhu X, Guo Z, Wang D, He X. Outcomes of Combined Liver and Pancreas Transplantation: A Review of the SRTR National Database and a Report of the Largest Single Center Series. Front Med (Lausanne) 2020; 7:542905. [PMID: 33195293 PMCID: PMC7605456 DOI: 10.3389/fmed.2020.542905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 08/31/2020] [Indexed: 11/15/2022] Open
Abstract
Purposes: This study was intended to summarize the characteristics and clinical outcome of Liver and Pancreas (LPTx) recipients in the Scientific Registry of Transplant Recipients (SRTR) database vs. the largest series from the First Affiliated Hospital (FAH), Sun Yat-sen University. Methods: The clinical data of 23 patients who underwent LPTx from 2000 to 2016 in the United States and 31 patients who underwent modified LPTx procedure (known as simplified multivisceral transplantation [SMT]) from 2008 to 2017 in our center were reviewed. The indications, surgical techniques, patient and graft survival, and complications were compared between the two groups. Results: All recipients in the FAH group were diagnosed with type 2 diabetes mellitus, while 10 of 23 recipients were diagnosed with type 1 diabetes mellitus in the SRTR group. The 1-, 3-, and 5-year cumulative patient survival rates were 81, 74, and 74% in the FAH group, respectively, and 51, 47, and 37% in the SRTR group, respectively (P = 0.023). No diabetes was observed during follow-up in the FAH group, while the diabetes recurrence rate was 22.2% in the SRTR group (P = 0.03). Conclusion: With multiple techniques modified and indications changed, the SMT procedure yielded a preferable outcome compared to that of the traditional LPTx procedure in records of SRTR. SMT has become a treatment option for patients with end-stage liver disease and concurrent diabetes.
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Affiliation(s)
- Cheukfai Li
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Science, Guangzhou, China
| | - Wei Zhang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiang Zhao
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Maodong Ye
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weiqiang Ju
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Linwei Wu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi Ma
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Anbin Hu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guodong Wang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaofeng Zhu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhiyong Guo
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dongping Wang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoshun He
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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3
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Chung W, Promrat K, Wands J. Clinical implications, diagnosis, and management of diabetes in patients with chronic liver diseases. World J Hepatol 2020; 12:533-557. [PMID: 33033564 PMCID: PMC7522556 DOI: 10.4254/wjh.v12.i9.533] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/03/2020] [Accepted: 08/15/2020] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus (DM) negatively affects the development and progression of chronic liver diseases (CLD) of various etiologies. Concurrent DM and CLD are also associated with worse clinical outcomes with respect to mortality, the occurrence of hepatic decompensation, and the development of hepatocellular carcinoma (HCC). Unfortunately, early diagnosis and optimal treatment of DM can be challenging, due to the lack of established clinical guidelines as well as the medical complexity of this patient population. We conducted an exploratory review of relevant literature to provide an up-to-date review for internists and hepatologists caring for this patient population. We reviewed the epidemiological and pathophysiological associations between DM and CLD, the impact of insulin resistance on the progression and manifestations of CLD, the pathogenesis of hepatogenic diabetes, as well as the practical challenges in diagnosis and monitoring of DM in this patient population. We also reviewed the latest clinical evidence on various pharmacological antihyperglycemic therapies with an emphasis on liver disease-related clinical outcomes. Finally, we proposed an algorithm for managing DM in patients with CLD and discussed the clinical and research questions that remain to be addressed.
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Affiliation(s)
- Waihong Chung
- Division of Gastroenterology, Department of Medicine, Rhode Island Hospital, Providence, RI 02905, United States.
| | - Kittichai Promrat
- Division of Gastroenterology and Hepatology, Providence VA Medical Center, Providence, RI 02908, United States
| | - Jack Wands
- Liver Research Center, The Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
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4
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Elsabbagh AM, Hawksworth J, Khan KM, Yazigi N, Matsumoto CS, Fishbein TM. World's smallest combined en bloc liver-pancreas transplantation. Pediatr Transplant 2018; 22:10.1111/petr.13082. [PMID: 29139617 PMCID: PMC6433131 DOI: 10.1111/petr.13082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2017] [Indexed: 11/30/2022]
Abstract
We present a case of a 2-year-old child who underwent a combined en bloc liver and pancreas transplant following complications of WRS. WRS is characterized clinically through infantile insulin-dependent diabetes mellitus, neutropenia, recurrent infections, propensity for liver failure following viral infections, bone dysplasia, and developmental delay. Usually, death occurs from fulminant liver and concomitant kidney failure. Few cases with WRS are reported in the literature, mostly from consanguineous parents. To the best of our knowledge, combined en bloc liver and pancreas transplant has not been performed in small children.
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Affiliation(s)
- Ahmed M. Elsabbagh
- MedStar Georgetown Transplant Institute; Georgetown University Hospital; Washington DC USA
| | - Jason Hawksworth
- MedStar Georgetown Transplant Institute; Georgetown University Hospital; Washington DC USA
| | - Khalid M. Khan
- MedStar Georgetown Transplant Institute; Georgetown University Hospital; Washington DC USA
| | - Nada Yazigi
- MedStar Georgetown Transplant Institute; Georgetown University Hospital; Washington DC USA
| | - Cal S. Matsumoto
- MedStar Georgetown Transplant Institute; Georgetown University Hospital; Washington DC USA
| | - Thomas M. Fishbein
- MedStar Georgetown Transplant Institute; Georgetown University Hospital; Washington DC USA
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5
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Li J, Guo QJ, Cai JZ, Pan C, Shen ZY, Jiang WT. Simultaneous liver, pancreas-duodenum and kidney transplantation in a patient with hepatitis B cirrhosis, uremia and insulin dependent diabetes mellitus. World J Gastroenterol 2017; 23:8104-8108. [PMID: 29259387 PMCID: PMC5725306 DOI: 10.3748/wjg.v23.i45.8104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/27/2017] [Accepted: 09/13/2017] [Indexed: 02/06/2023] Open
Abstract
Simultaneous liver, pancreas-duodenum, and kidney transplantation has been rarely reported in the literature. Here we present a new and more efficient en bloc technique that combines classic orthotopic liver and pancreas-duodenum transplantation and heterotopic kidney transplantation for a male patient aged 44 years who had hepatitis B related cirrhosis, renal failure, and insulin dependent diabetes mellitus (IDDM). A quadruple immunosuppressive regimen including induction with basiliximab and maintenance therapy with tacrolimus, mycophenolate mofetil, and steroids was used in the early stage post-transplant. Postoperative recovery was uneventful and the patient was discharged on the 15th postoperative day with normal liver and kidney function. The insulin treatment was completely withdrawn 3 wk after operation, and the blood glucose level remained normal. The case findings support that abdominal organ cluster and kidney transplantation is an effective method for the treatment of end-stage liver disease combined with uremia and IDDM.
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Affiliation(s)
- Jiang Li
- Department of Liver Transplant, Tianjin First Central Hospital, Tianjin 300192, China
| | - Qing-Jun Guo
- Department of Liver Transplant, Tianjin First Central Hospital, Tianjin 300192, China
| | - Jin-Zhen Cai
- Department of Liver Transplant, Tianjin First Central Hospital, Tianjin 300192, China
| | - Cheng Pan
- Department of Liver Transplant, Tianjin First Central Hospital, Tianjin 300192, China
| | - Zhong-Yang Shen
- Department of Liver Transplant, Tianjin First Central Hospital, Tianjin 300192, China
| | - Wen-Tao Jiang
- Department of Liver Transplant, Tianjin First Central Hospital, Tianjin 300192, China
- Department of Transplant Surgery, Tianjin First Central Hospital, Tianjin 300192, China
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6
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He XS, Fu SJ, Zhao Q, Zhu XF, Wang DP, Han M, Ju WQ, Ma Y, Jiao XY, Yuan XP, Hu AB, Guo ZY. A simplified multivisceral transplantation procedure for patients with combined end-stage liver disease and type 2 diabetes mellitus. Liver Transpl 2017; 23:1161-1170. [PMID: 28422396 DOI: 10.1002/lt.24774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 03/25/2017] [Accepted: 04/06/2017] [Indexed: 01/13/2023]
Abstract
In liver transplant patients with type 2 diabetes mellitus (DM), the disease worsens after transplantation because of longterm use of diabetogenic immunosuppressive drugs, making management of those patients a great challenge. The objective of our study was to evaluate the safety and efficacy of a simplified multivisceral transplantation (SMT) procedure for the treatment of patients with end-stage liver disease and concurrent type 2 DM. Forty-four patients who had pretransplant type 2 DM were included. A total of 23 patients received SMT, and 21 patients received orthotopic liver transplantation (OLT). Patient and graft survivals, complications, diabetic control, and quality of life (QOL) were retrospectively analyzed in both groups. The 1-, 3-, and 5-year cumulative patient and graft survival rates were 91.5%, 75.4%, and 75.4% in the SMT group and were 94.4%, 64.4%, and 64.4% in the OLT group, respectively (P = 0.70). Interestingly, 95.7% (22/23) of patients achieved complete remission from DM after SMT compared with 16.7% (3/18) of patients after OLT. The occurrence of biliary complication was significantly higher in the OLT group than that in the SMT group (23.8% versus 0.0%; P = 0.01). Moreover, better QOL was observed in the SMT group than that in the OLT group. In conclusion, the SMT procedure we described here is a safe and viable option for patients with end-stage live disease and concurrent type 2 DM. This SMT procedure offers excellent transplant outcomes and QOL. Liver Transplantation 23 1161-1170 2017 AASLD.
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Affiliation(s)
- Xiao-Shun He
- Organ Transplant Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People's Republic of China.,Organ Transplantation, Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, People's Republic of China
| | - Shun-Jun Fu
- Organ Transplant Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People's Republic of China.,Organ Transplantation, Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, People's Republic of China
| | - Qiang Zhao
- Organ Transplant Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People's Republic of China.,Organ Transplantation, Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, People's Republic of China
| | - Xiao-Feng Zhu
- Organ Transplant Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People's Republic of China.,Organ Transplantation, Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, People's Republic of China
| | - Dong-Ping Wang
- Organ Transplant Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People's Republic of China.,Organ Transplantation, Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, People's Republic of China
| | - Ming Han
- Organ Transplant Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People's Republic of China.,Organ Transplantation, Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, People's Republic of China
| | - Wei-Qiang Ju
- Organ Transplant Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People's Republic of China.,Organ Transplantation, Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, People's Republic of China
| | - Yi Ma
- Organ Transplant Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People's Republic of China.,Organ Transplantation, Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, People's Republic of China
| | - Xing-Yuan Jiao
- Organ Transplant Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People's Republic of China.,Organ Transplantation, Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, People's Republic of China
| | - Xiao-Peng Yuan
- Organ Transplant Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People's Republic of China.,Organ Transplantation, Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, People's Republic of China
| | - An-Bin Hu
- Organ Transplant Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People's Republic of China.,Organ Transplantation, Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, People's Republic of China
| | - Zhi-Yong Guo
- Organ Transplant Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, People's Republic of China.,Organ Transplantation, Guangdong Provincial International Cooperation Base of Science and Technology, Guangzhou, People's Republic of China
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7
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Deylgat B, Topal H, Meurisse N, Jochmans I, Aerts R, Vanbeckevoort D, Monbaliu D, Pirenne J. Gastric outlet obstruction by a donor aortic tube after en bloc liver pancreas transplantation: a case report. Transplant Proc 2012; 44:2888-92. [PMID: 23146548 DOI: 10.1016/j.transproceed.2012.09.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We present the case of a 30-year-old female suffering from a type five maturity onset diabetes of the young deficiency, resulting in type 1 diabetes and terminal renal insufficiency. She also had chronic and refractory pruritis due to primary sclerosing cholangitis-like fibrosis. She underwent combined en bloc liver and pancreas transplantation and kidney transplantation. The postoperative course was complicated by a gastric outlet obstruction due to compression of the native gastroduodenal junction by the donor aortic tube. This was treated by construction of a roux-en-Y gastrojejunostomy at posttransplant day 24. To our knowledge, compression of the gastroduodenal junction by a donor aortic tube after combined liver and pancreas (or multivisceral) transplantation has not been reported previously.
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Affiliation(s)
- B Deylgat
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
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8
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Schnitzbauer AA, Woeste G, Ulrich F, Bechstein WO. Indikationen und Komplikationen bei Multiorgantransplantationen. VISZERALMEDIZIN 2012. [DOI: 10.1159/000343766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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9
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Chen ZS, Meng FY, Chen XP, Liu DG, Wei L, Jiang JP, Du DF, Zhang WJ, Ming CS, Gong NQ. Combined en bloc liver/pancreas transplantation in two different patients. World J Gastroenterol 2009; 15:2552-5. [PMID: 19469010 PMCID: PMC2686918 DOI: 10.3748/wjg.15.2552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Combined en bloc liver/pancreas transplantation (CLPT) was used primarily in the treatment of otherwise non-resectable upper abdominal malignancy. In fact, a more appropriate indication is in patients with liver disease and insulin-dependent diabetes mellitus (IDDM). Here, we report on two successful cases of CLPT at our hospital. One was a patient with non-resectable advanced liver cancer. The recipient survived for 23 mo and finally died of recurrent tumor. The other was a patient with severe biliary complication after orthotopic liver transplantation and preoperative IDDM. We performed CLPT with a modified surgical technique of preserving the native pancreas. He is currently liver-disease- and insulin-free more than 27 mo post-transplant. Based on our experience in two cases of abdominal cluster transplantation, we describe the technical details of CLPT and a modification of the surgical procedure.
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10
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Combined En-bloc Liver-Pancreas Transplantation in Patients With Liver Cirrhosis and Insulin-Dependent Type 2 Diabetes Mellitus. Transplantation 2009; 87:542-5. [DOI: 10.1097/tp.0b013e3181949cce] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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11
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Pirenne J, Aerts R, Monbaliu D, Coosemans W, Vlasselaers D, Desmet L, Herman J, Hoffman I, Lombaerts R. Results of Pediatric Liver Transplantation in an Originally Adult Liver Transplant Program. Transplant Proc 2007; 39:2672-4. [DOI: 10.1016/j.transproceed.2007.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Harary AM, Abu-Elmagd K, Thai N, Shapiro R, Todo S, Fung JJ, Starzl TE. World's longest surviving liver-pancreas recipient. Liver Transpl 2007; 13:957-60. [PMID: 17600350 PMCID: PMC2994251 DOI: 10.1002/lt.21223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In July 1988, the liver and pancreas of a cadaveric donor were transplanted separately into a man with type 1 diabetes with end-stage chronic hepatitis B virus. Two features of the operation may help explain the patient's current status as the longest-lived liver-pancreas recipient. One was enteric drainage of pancreatic exocrine secretions. The other was delivery of the pancreas venous effluent to the host portal system and then directly to the hepatic allograft.
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Affiliation(s)
- Albert M. Harary
- New York University School of Medicine and Lenox Hill Hospital, New York, NY
| | - Kareem Abu-Elmagd
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ngoc Thai
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ron Shapiro
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Satoru Todo
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - John J. Fung
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Thomas E. Starzl
- Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
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13
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Mekeel KL, Langham MR, Gonzalez-Perralta R, Reed A, Hemming AW. Combined en bloc liver pancreas transplantation for children with CF. Liver Transpl 2007; 13:406-9. [PMID: 17318857 DOI: 10.1002/lt.21070] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cystic fibrosis (CF) is an inherited genetic defect in epithelial chloride transport that results a multisystem disease affecting the sweat glands and the pulmonary and digestive systems. Although pulmonary disease remains the primary cause of morbidity and mortality in these patients, up to 8% may develop focal biliary cirrhosis and portal hypertension. Liver transplantation is an accepted therapy for these patients. About 85% of CF patients develop pancreatic exocrine insufficiency and up to 34% will develop diabetes requiring insulin. We describe a series of 9 patients who underwent liver transplantation (6 transplantation of liver only [LO], and 3 combined en bloc liver-pancreas [LP] transplantation) for CF-related liver disease at our institution,. All 9 patients had pretransplant pancreatic exocrine insufficiency requiring enzyme supplementation. Of the 9, 5 patients (55%) had preoperative insulin dependent diabetes, including all 3 patients who underwent liver pancreas transplantation. Liver-pancreas transplants were performed en bloc. One-year patient survival for both LO and LP patients was 100%. Five-year patient survival was 83% for the LO patients and 100% for the LP patients. All LP patients are off insulin and do not require pancreatic enzyme supplementation. All patients receiving LO continue to need exogenous pancreatic enzyme supplementation. In the 6 patients who received LO, 2 were insulin dependent prior to surgery, and they remain insulin dependent after transplant. Of the 4 patients who received LO who were not insulin dependent pretransplant, 3 have now developed insulin-dependent diabetes. Patients receiving LO were more likely to be diabetic and require exogenous pancreatic enzymes after transplant than those receiving LP (83% vs. 0%, P = 0.04, and 100% vs. 0%, P = 0.01, respectively). In conclusion, patients with CF and end-stage liver disease requiring liver transplantation may benefit from combined liver-pancreas transplantation.
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Affiliation(s)
- Kristin L Mekeel
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610, USA
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14
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Young AL, Peters CJ, Toogood GJ, Davies MH, Millson CE, Lodge JPA, Pollard SG, Prasad KR. A combined liver-pancreas en-bloc transplant in a patient with cystic fibrosis. Transplantation 2005; 80:605-7. [PMID: 16177633 DOI: 10.1097/01.tp.0000167007.58199.9b] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Alistair L Young
- Transplant and Hepatobiliary Unit, St. James' University Hospital, Leeds, UK
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15
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Fridell JA, Vianna R, Kwo PY, Howenstine M, Sannuti A, Molleston JP, Pescovitz MD, Tector AJ. Simultaneous Liver and Pancreas Transplantation in Patients With Cystic Fibrosis. Transplant Proc 2005; 37:3567-9. [PMID: 16298663 DOI: 10.1016/j.transproceed.2005.09.091] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Improved survival in patients with cystic fibrosis (CF) has led to an increased incidence of extrapulmonary complications of this disease. Of these, cirrhosis and pancreatic insufficiency, including CF-related diabetes (CFRD) and exocrine insufficiency, are significant causes of morbidity and mortality. Liver transplantation is the treatment of choice for cirrhosis in this setting, but the addition of an isolated simultaneous pancreas transplant in patients with CFRD has not been reported. METHODS Two female patients with CF underwent simultaneous pancreas and liver transplantation. Both had pancreatic insufficiency, CFRD, cirrhosis, and preserved renal function. In each case, the liver and pancreas were procured from a single cadaveric donor. The liver transplant was performed first. A lower midline extension was added for improved exposure of the iliac vessels. The donor pancreas transplant was performed with systemic venous drainage and enteric exocrine drainage. Immunosuppression included rabbit anti-thymocyte globulin, tacrolimus, mycophenolate mofetil, and early steroid withdrawal. RESULTS Both patients recovered well with normal liver function, resolution of portal hypertension, and normal blood glucoses independent of insulin. As a result of the enteric exocrine drainage of the pancreas, they are now independent of supplemental pancreatic enzymes. CONCLUSIONS Simultaneous liver and pancreas transplantation in CF patients provides the advantages of normalization of glucose and improved nutrition for patients requiring liver transplantation and should be considered in CF patients with CFRD who require liver transplants.
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Affiliation(s)
- J A Fridell
- Department of Surgery, Indiana University, 550 N. University Boulevard #4258, Indianapolis, IN 46202, USA.
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