Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-25T04:18:08.289Z Has data issue: false hasContentIssue false
  • English
  • Français

Pancreatic Transplantation

Published online by Cambridge University Press:  10 March 2009

G. Tydén  and
C. G. Groth
G. Tydén
Affiliation:
Karolinska Institute
C. G. Groth
Affiliation:
Karolinska Institute
Get access Rights & Permissions [Opens in a new window]

Extract

Insulin dependent diabetes mellitus ranks as one of the major disease entities in the world. It is widespread in industrialized countries as well as in developing countries. In spite of the considerable improvements in conventional diabetes therapy during the past few years, severe secondary complications still develop in most patients. The National Commission on Diabetes in the United States has reported that patients with insulin dependent diabetes are 25 times more prone to blindness, 17 times more prone to kidney disease, 5 times more often afflicted with gangrene and twice as often afflicted with heart disease than are non-diabetic individuals. In Sweden diabetes is now the second most common cause of uremia and it is the most common cause of blindness in adults. The life expectancy for the diabetic patient is approximately one-third less than that of the general population. Since the metabolic abnormalities that prevail in diabetes mellitus are due to abolished beta-cell function, it would seem logical to treat this disease by the transplantation of normally functioning islets of Langerhans. This operation should correct the metabolic abnormalities and presumably prevent or delay the severe secondary complications. There are two ways of transplanting the endocrine pancreas, either by means of a vascularized graft or by providing free, isolated islets. Unfortunately it has not been possible, so far, to correct diabetes in humans with islet transplantation. However, during the last years there has been substantial progress in the field of vascularized pancreatic transplantation and the results now begin to approach those obtained with other organs such as the kidney, heart, and liver.

Type
Special Section: Transplantation and Artificial Organs
Information
International Journal of Technology Assessment in Health Care , Volume 2 , Issue 3 , July 1986 , pp. 483 - 496
Copyright
Copyright © Cambridge University Press 1986

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Baumgartner, D., Largiader, F., Uhlschmid, G., & Binswanger, U.Rejection episodes in recipients of simultaneous pancreas and kidney transplantation. Transplantation Proceedings, 1983, 15, 1330–31.Google Scholar
2.Bohman, S-O., Tydén, G., Wilczek, H., et al. Prevention of kidney graft diabetic nephropathy by pancreas transplantation in man. Diabetes, 1985, 34, 306–08.CrossRefGoogle ScholarPubMed
3.Brekke, I. B., Dyrbekk, D., Jakobsen, A., Jervell, J., Sodal, G., & Flatmark, A.Improved pancreas graft survival in combined pancreatic and renal transplantation. Transplantation Proceedings, 1986, 18, 63–4.Google Scholar
4.Calne, R. Y. & Brons, I. G. M.Observations on paratopic segmental pancreas grafting with splenic venous drainage. Transplantation Proceedings, 1985, 17, 340–42.Google Scholar
5.Corry, R. J., Nghiem, D. D., Schulak, J. A., Beutel, W. D., & Gonwa, T. A.Surgical treatment of diabetic nephropathy with simultaneous pancreatic duodenal and renal transplantation. Surgery, Gynecology & Obstetrics, 1986, 162, 547–555.Google ScholarPubMed
6.Dubernard, J. M., Traeger, J., Neyra, P., Touraine, J. L., Tranchant, D., & Blanc-Brunat, N.A new method of preparation of segmental pancreatic grafts for transplantation: Trials in dogs and in man. Surgery, 1978, 84, 633–106Google ScholarPubMed
7.Malik, M. C.Rejection of human pancreatic allografts. Transplantation Proceedings, 1980, 12, 103–06.Google Scholar
8.Dubernard, J. M., Traeger, J., Piatti, P. M. et al. Report of 54 human segmental pancreatic allografts prepared by duct obstruction with neoprene. Transplantation Proceedings, 1985, 17, 312–14.Google Scholar
9.Engfeldt, P., Tydén, G., Gunnarsson, R., Östman, J., & Groth, C. G.Impaired glucose tolerance with cyclosporin. Transplantation Proceedings, 1986, 18, 65–6.Google Scholar
10.Florack, G., Sutherland, D. E. R., Sibley, R. K., Najarian, J. S. & Squifflet, J. P.Combined kidney and segmental pancreas allotransplantation in dogs. Transplantation Proceedings, 1985, 17, 374–77.Google Scholar
11.Gil-Vernet, J. M., Fernandez-Cruz, L., Andreu, J., Figuerola, D., & Caralps, A.Clinical experience with pancreaticopyelostomy for exocrine pancreatic drainage and portal venous drainage in pancreas transplantation. Transplantation Proceedings, 1985, 17, 342–45.Google Scholar
12.Gliedman, M. L., Tellis, V. A., Soberman, R., Rifkin, H. & Veith, F. J.Long-term effects of pancreatic transplant function in patients with advanced juvenile-onset diabetes. Diabetes Care, 1978, 1, 1–9.CrossRefGoogle ScholarPubMed
13.Groth, C. G., Lundgren, G., Arner, P., et al. Rejection of isolated pancreatic allografts in patients with diabetes. Surgery, Gynecology & Obstetrics, 1976, 143, 933–40.Google Scholar
14.Groth, C. G., Lundgren, G., Gunnarsson, R., Arner, P., Berg, B., & Östman, J.Segmental pancreatic transplantation with duct ligation or drainage to a jejunal Roux-en-Y loop in nonuremic diabetic patients. Diabetes, 1980, 29, 3–9.CrossRefGoogle ScholarPubMed
15.Groth, C. G., Lundgren, G., Östman, J., & Gunnarsson, R.Experience with nine segmental pancreatic transplantations in preuremic diabetic patients in Stockholm. Transplantation Proceedings, 1980, 12, 68–72.Google ScholarPubMed
16.Groth, C. G., Lundgren, G., Gunnarsson, R., Hárdstedt, C. & Östman, J.Segmental pancreatic transplantation with special reference to the use of ileal exocrine diversion and to the hemodynamics of the graft. Transplantation Proceedings, 1980, 12, 62–67.Google Scholar
17.Groth, C. G., Collste, H., Lundgren, G., et al. Successful outcome of segmental human pancreatic transplantation with enteric exocrine diversion after modifications in technique. Lancet, 1982, 2, 522–24.CrossRefGoogle ScholarPubMed
18.Groth, C. G., Collste, H., Lundgren, G., et al. Surgical techniques for pancreatic transplantation. A critical appraisal of methods used and a suggested new modification. Hormonel and Metabolic Research, 1983, Suppl 13, 37–46.Google Scholar
19.Groth, C. G., Lundgren, H., Wilczek, H., et al. Segmental pancreatic transplantation with duct ligature or enteric diversion: Technical aspects. Transplantation Proceedings, 1984, 16, 724–28.Google ScholarPubMed
20.Gunnarsson, R., Klintmalm, G., Lundgren, G., et al. Deterioration in glucose metabolism in pancreatic transplant recipients after conversion from azathioprine to cy-closporine. Transplantation Proceedings, 1984, 16, 709–12.Google Scholar
21.Kocandrle, V., Vanek, I., Bartos, V., Pavel, P.Splenic artery interposition in animal and human segmental pancreatic transplantation. Transplantation Proceedings, 1984, 16, 1283–84.Google ScholarPubMed
22.Land, W., Landgraf, R., Illner, W-D., et al. Improved results in combined segmental pancreatic and renal transplantation in diabetic patients under cyclosporine therapy. Transplantation Proceedings, 1985, 17, 317–24.Google Scholar
23.Landgraf, R., Landgraf-Leurs, M. M. C., Burg, D., et al. Long-term follow-up of segmental pancreas transplantation in type I diabetes. Transplantation Proceedings (in press).Google Scholar
24.Largiader, F., Uhlschmid, G., Binswanger, U., & Zaruba, K.Pancreas rejection in combined pancreatico-duodenal and renal allotransplantation in kidney. Transplantation, 1975, 19, 185–87.CrossRefGoogle Scholar
25.Lillehei, R. C., Simmons, R. L., Najarian, J. S., et al. Pancreatico-duodenal allotransplantation: experimental and clinical experience. Annals of Surgery, 1970, 172, 405–36.CrossRefGoogle ScholarPubMed
26.Lillehei, R. C., Simmons, R. L., Najarian, J. S., Kjellstrand, C. M., & Goetz, F. C.Current state of pancreatic allotransplantation. Transplantation Proceedings, 1971, 3, 318–24.Google ScholarPubMed
27.Mauer, S. M., Steffes, M. W., Ellis, E. N., et al. Structural-functional relationship in diabetic nephropathy. Journal of Clinical Investigation, 1984, 74, 1143–55.CrossRefGoogle ScholarPubMed
28.McMaster, P., Michael, J., Adu, D., Vlassis, T., & Gibby, O.Combined kidney and pancreas transplantation in man: Experience at the University of Birmingham. Diabetic Nephropathy, 1985, 4, 135–39.Google Scholar
29.Östman, J., Arner, P., Groth, C. G., Gunnarsson, R., Heding, L. & Lundgren, G.Plasma C-peptide and serum insulin antibodies in diabetic patients receiving pancreatic transplants. Diabetologia, 1980, 19, 25–30.CrossRefGoogle ScholarPubMed
30.Pozza, G., Traeger, J., Dubernard, J. M., et al. Endocrine responses of type 1 (insulin-dependent) diabetic patients following successful pancreas transplantation. Diabetologia, 1983, 24, 244–48.CrossRefGoogle ScholarPubMed
31.Schulak, J. A., & Drevyanko, T. F.Experimental pancreas allograft rejection: Correlation between histologic and functional rejection and the efficacy of antirejection therapy. Surgery, 1984, 98, 330–36.Google Scholar
32.Sollinger, H. W., Kalayoglu, M., Hoffman, R. M., & Belzer, F. O.Results of segmental and pancreaticosplenic transplantation with pancreaticocystostomy. Transplantation Proceedings, 1985, 17, 360–62.Google Scholar
33.Starzl, T. E., Iwatsuki, S., Shaw, B. W., et al. Pancreaticoduodenal transplantation in humans. Surgery Gynecology & Obstetrics, 1984, 159, 265–72.Google ScholarPubMed
34.Sutherland, D. E. R., Goetz, F. C., Carpenter, A. M., Najarian, J. S., & Lillehei, R. C.Pancreaticoduodenal grafts: Clinical and pathological observations in uremic versus nonuremic recipients. Transplantation and Clinical Immunology, 1978, 10, 190–95.Google Scholar
35.Sutherland, D. E. R., Goetz, F. C., & Najarian, J. S.One hundred pancreas transplants at a single institution. Annals of Surgery, 1984, 200, 414–40.CrossRefGoogle ScholarPubMed
36.Sutherland, D. E. R., Kendall, D., Goetz, F. C., & Najarian, J. S. Pancreas transplantation in man. The Diabetes Annual. New York: Elsevier, 198–216.Google Scholar
37.Sutherland, D. E. R., Goetz, F. C., Kendall, D. M., & Najarian, J. S.One institution's experience with pancreas transplantation. The Western Journal of Medicine, 1985, 14, 838–44.Google Scholar
38.Sutherland, D. E. R. & Kendall, D. M.Pancreas transplantation—registry report and a commentary. The Western Journal of Medicine, 1985, 143, 845–52.Google Scholar
39.Svahn, T., Lewander, R., Hardstedt, C., Lundgren, G., Sundelin, P., & Groth, C. G.Angiography and scintigraphy of human pancreatic allografts. Acta Radiologica Diagnosis, 1977, 19, 297–304.CrossRefGoogle Scholar
40.Telford, G. L. & Mason, R. G.Pancreaticogastrostomy: Clinical experience with a direct pancreatic-duct-to-gastric-mucosa anastomosis. The American Journal of Surgery, 1984, 147, 832–37.CrossRefGoogle ScholarPubMed
41.Traeger, J., Dubernard, J. M., Monti, L. D., et al. Studies in patients with a segmental pancreatic graft functioning more than 1 year. Transplantation Proceedings (in press).Google Scholar
42.Tydén, G., Lundgren, G., Östman, J., Gunnarsson, R., & Groth, C. G.Grafted pancreas with portal venous drainage. Lancet, 1984, 1, 964–65.Google Scholar
43.Tydén, G., Wilczek, H., Lundgren, G., et al. Experience with 21 intraperitoneal segmental pancreatic transplants with enteric or gastric exocrine diversion in humans. Transplantation Proceedings, 1985, 17, 331–35.Google Scholar
44.Tydén, G., Lundgren, G., Öst, L., Gunnarsson, R., Östman, J., & Groth, C. G.Are pancreatic grafts prone to reject. Transplantation Proceedings, 1986, 18, 27–9.Google Scholar
45.Tydén, G., Brattstrom, C., Häggmark, A., & Groth, C. G. Studies on the exocrine secretion of human segmental pancreatic grafts. Surgery, Gynecology & Obstetrics (in press).Google Scholar
46.Wilczek, H., Gunnarsson, R., Lundgren, G., & Öst, L.Improved results of renal transplantation in diabetic nephropathy. Transplantation Proceedings, 1984, 16, 623–25.Google ScholarPubMed
47.Wilczek, H., Gunnarsson, R., Felig, P., Wahren, J., & Groth, C. G.Normalization of hepatic glucose regulation following heterotopic pancreatic transplantation in humans. Transplantation Proceedings, 1985, 17, 315–16.Google Scholar