One Hundred Pancreas Transplants Performed in a Brazilian Institution

doi:10.1016/j.transproceed.2009.09.064

Transplantation Proceedings

Volume 41, Issue 10, December 2009, Pages 4270-4273

https://doi.org/10.1016/j.transproceed.2009.09.064 Get rights and content

Abstract

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.

Section snippets

Study Population

Between January 2001 and January 2008, 100 patients underwent pancreatic transplantation at our center: 88 simultaneous pancreas-kidney transplantation (SPK) and 12 pancreas transplantation alone (PTA). All of them were primary transplants.

The duration of diabetes tended to be shorter among PTA recipients (mean = 20 ± 8 years) versus SPK (25 ± 8 years). Overall the proportion of female pancreas recipients was slightly less than men in the SPK (43%) and PTA (47%) categories.

PTA was indicated

Cadaver Donor Age

The age range was 10 to 55 years. The donors tended to be older for PTA than for SPK recipients, namely, mean ages of 28 ± 18 versus 38 ± 17 years.

Cadaver Donor Cause of Death

The proportion of cadaver donors who died due to trauma was 69% of those younger than 45 years, and 20% of those 45 or older. Cardiocerebral vascular disease was responsible for the other donors.

Discussion

For decades, elevations in blood glucose have been clearly associated with an increased risk of microvascular complications of diabetes. Due the limitations of intensive insulin therapy for selected patients, transplantation of pancreatic islet beta cells through a vascularized pancreatic graft has been shown to be effective, prolonging the survival of diabetic patients.¹

The Brazilian pancreas graft allocation system initially includes a local (state) level, and then a regional and national

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There are more references available in the full text version of this article.

Cited by (5)

Development and results of a novel pancreas transplant program in Spain: the surgeon's point of view
2018, Cirugia Espanola
El trasplante simultáneo de páncreas-riñón se encuentra indicado para pacientes con diabetes tipo 1 y enfermedad renal terminal. Los resultados son excelentes aunque el número de procedimientos parece ser un factor que afecta a la supervivencia de paciente e injerto estando en relación con la morbilidad quirúrgica, derivada de complicaciones pancreáticas. el objetivo del estudio es describir el desarrollo de un nuevo programa y exponer los resultados en un centro con un volumen bajo de trasplantes.
Analizamos 53 trasplantes simultáneos de páncreas-riñón, en un período de 7 años (2009-2016), con una mediana de seguimiento de 39 meses.
Dos pacientes han fallecido, uno tras parada cardíaca en postoperatorio y otro tras accidente de tráfico complicado con una neumonía. Entre los 51 pacientes vivos se han perdido 2 injertos, uno por un rechazo crónico tras cuatro años del trasplante y otro por trombosis arterial a los 20 días del mismo, motivo, este último, de la única trasplantectomía realizada. En diez pacientes se han realizado una o más reintervenciones: pancreatitis (n=3), oclusión intestinal (n=4), trombosis arterial (n=1), fístula con peritonitis (n=1) y hemoperitoneo (n=1). La supervivencia del paciente y del injerto a 1, 3, y 5 años fue del 98, 95 y 95% y del 96, 93 y 89%, respectivamente.
Los resultados muestran que un nuevo programa de trasplante pancreático puede conseguir resultados similares a los de grupos con mayor volumen y experiencia. Una adecuada selección de donantes y receptores, una técnica homogénea y el aprendizaje con grupos expertos garantizan estos resultados.
Simultaneous kidney-pancreas transplantation for patients with type 1 diabetes and end-stage chronic renal disease is widely performed. However, the rate of surgical morbidity from pancreatic complications remains high. The aim of this study was to describe the development and results of a new program, from the point of view of the pancreatic surgeon.
We analyzed 53 simultaneous kidney-pancreas transplantations performed over a period of seven years (2009-2016), with a median follow up of 39 months (range: 1-86 months).
Out of the total of this series, two patients died: one patient because of cardiac arrest immediately after surgery; and another patient due to traffic accident, complicated by pneumonia. Among the 51 living patients, two grafts were lost: one due to chronic rejection four years after transplantation; and the other due to arterial thrombosis 20 days after transplantation (the only case requiring transplantectomy). In ten patients, one or more re-operations were necessary due to the following: graft pancreatitis (n=4), small intestinal obstruction (n=4), arterial thrombosis (n=1), fistula (n=1) and hemoperitoneum (n=1). Overall patient and graft survival rates after 1, 3 and 5 years were 98, 95 and 95% and 96, 93 and 89%, respectively.
This study has shown that the results of a new pancreas transplant program, which relies on the previous experience of other groups, do not demonstrate a learning curve. Adequate surgeon education and training, as well as the proper use of standardized techniques, should ensure optimal results.
Qualitative analysis of the deposit of collagen in bladder suture of rats treated with tacrolimus combined with mycophenolate-mofetil
2014, International Braz J Urol
Over 500 pancreas transplants by a single team in São Paulo, Brazil
2011, Clinical Transplantation
Action of tacrolimus in Arginine induced experimental acute pancreatitis
2011, Revista do Colegio Brasileiro de Cirurgioes
A retrospective monocenter review of simultaneous pancreas- kidney transplantation with bladder drainage in China
2011, Chinese Medical Journal

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Transplantation Proceedings

Abstract

Section snippets

Study Population

Cadaver Donor Age

Cadaver Donor Cause of Death

Categories

Discussion

References (16)

Celsior versus wisconsin solution in pancreas transplantation

Transplant Proc

Successful pancreas-renal transplantation without induction therapy

Transplant Proc

Simultaneous pancreas-kidney transplantation: a single-center experience and prospective analysis

Transplant Proc

Surgical complications after pancreas transplantation with portal-enteric drainage

J Am Coll Surg

Lessons learned from more than 1,000 pancreas transplants at a single institution

Ann Surg

Pancreas transplant outcomes for United States (US) and non-US cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR) as of June 2004

Clin Transplant

Pancreas preservation for pancreas and islet transplantation

Curr Opin Organ Transplant

Donor procedures

Cited by (5)

Development and results of a novel pancreas transplant program in Spain: the surgeon's point of view

Qualitative analysis of the deposit of collagen in bladder suture of rats treated with tacrolimus combined with mycophenolate-mofetil

Over 500 pancreas transplants by a single team in São Paulo, Brazil

Action of tacrolimus in Arginine induced experimental acute pancreatitis

A retrospective monocenter review of simultaneous pancreas- kidney transplantation with bladder drainage in China

Pancreas transplantationOne Hundred Pancreas Transplants Performed in a Brazilian Institution

Abstract

Section snippets

Study Population

Cadaver Donor Age

Cadaver Donor Cause of Death

Categories

Discussion

Transplant Proc

Transplant Proc

Transplant Proc

J Am Coll Surg

Lessons learned from more than 1,000 pancreas transplants at a single institution

Ann Surg

Pancreas transplant outcomes for United States (US) and non-US cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR) as of June 2004

Clin Transplant

Pancreas preservation for pancreas and islet transplantation

Curr Opin Organ Transplant

Donor procedures

Pancreas transplantation
One Hundred Pancreas Transplants Performed in a Brazilian Institution