A prospective comparison of simultaneous kidney-pancreas transplantation with systemic-enteric versus portal-enteric drainage
| Autor: | Hani P. Grewal, Lillian W. Gaber, M. H. Shokouh-Amiri, M.F Egidi, Robert J. Stratta, and A. Gaber, A.T Kizilisik, Nosrat Nezakatgoo |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Monitoring medicine.medical_treatment Pancreas transplantation Antibiotic Prophylaxis Drainage Female Humans Immunosuppressive Agents Insulin Length of Stay Middle Aged Monitoring Physiologic Portal Vein Postoperative Complications Postoperative Period Prospective Studies Survival Rate Kidney Transplantation Pancreas Transplantation Insulin resistance Diabetes mellitus medicine Glucose homeostasis Physiologic Kidney transplantation business.industry Scientific Papers of the Southern Surgical Association Immunosuppression medicine.disease Surgery Transplantation medicine.anatomical_structure Pancreas business |
| Zdroj: | Annals of surgery. 233(6) |
| ISSN: | 0003-4932 |
| Popis: | Vascularized pancreas transplantation was developed as a means to reestablish endogenous insulin secretion responsive to normal feedback controls. Pancreas transplantation is currently the only available form of autoregulating total endocrine replacement therapy that reliably establishes an insulin-independent euglycemic state and normal glucose homeostasis, resulting in the successful treatment of diabetes mellitus. With improvements in organ retrieval and preservation technology, refinements in diagnostic technology and surgical techniques, advances in clinical immunosuppression and antimicrobial prophylaxis, and experience in donor and recipient selection, success rates for pancreas transplantation have steadily increased. From 1966 through July 2000, more than 14,000 pancreas transplants were performed worldwide and reported to the International Pancreas Transplant Registry (IPTR). 1 In the United States, more than 1,200 pancreas transplants are performed annually, with 83% being simultaneous kidney and pancreas transplantations (SKPTs). The current 1-year actuarial patient, kidney, and pancreas (with complete insulin independence) graft survival rates after SKPT are 95%, 92%, and 84%, respectively. 1 With the advent of Medicare coverage, SKPT has become accepted as the preferred treatment option in selected patients with insulin-dependent diabetes mellitus and advanced nephropathy. The history of clinical pancreas transplantation largely revolves around the development and application of various surgical techniques. According to IPTR data, most pancreas transplants are performed with systemic venous delivery of insulin and either bladder (systemic-bladder [SB]) or enteric (systemic-enteric [SE]) drainage of the exocrine secretions. 1,2 From 1988 through 1995, more than 90% of pancreas transplants were performed by the standard technique of SB drainage. 2 With an evolution in surgical techniques, a resurgence of interest has occurred in enteric exocrine drainage. Since 1995, the number of pancreas transplants performed with primary enteric drainage has steadily increased, accounting for 60% of cases in 1999. 1 Most pancreas transplants with enteric drainage are performed with systemic venous delivery of insulin (SE technique). 2 To improve the physiology of pancreas transplantation and to avoid the potential complications of systemic hyperinsulinemia (e.g., dyslipidemia, accelerated atherosclerosis, and insulin resistance), a new surgical technique was developed at our center using portal venous delivery of insulin and enteric drainage of the exocrine secretions (portal-enteric [PE]). 3,4 However, the proportion of cases with enteric exocrine drainage coupled with portal venous delivery of insulin has remained low and represents only 15% to 20% of enteric-drained pancreas transplants. 2 In the most recent IPTR analysis including pancreas transplants performed between 1996 to 1999, the 1-year pancreas graft survival rates were similar for PE versus SE drainage (83% and 84%, respectively). 1 The purpose of this study was to compare SKPT with SE versus PE drainage in a prospective fashion with standardized immunosuppression. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|