Combined liver and islet transplantation: about one case

Autor: Franco Barbazza, R. Vecchioni, F. Meduri, E. Di Marzio, Giorgio Enrico Gerunda, Roberto Merenda, Daniele Neri, A. Maffei Faccioli, G. Della Giacoma, Rosa Maria Iemmolo, Massimo Rossi, A Bruttocao
Rok vydání: 1997
Předmět:
Zdroj: Transplant International. 10:164-166
ISSN: 1432-2277
0934-0874
DOI: 10.1111/j.1432-2277.1997.tb00563.x
Popis: Sir: The first attempt to perform combined liver and islet transplantation was made by Tzakis et al. [15] in patients submitted to modified cluster transplantation [14-161. Subsequently, the same authors extended the indication of this treatment to patients affected with endstage liver disease and type I diabetes [5,9], but the results were not very encouraging since none of the patients obtained an insulin-free condition. The same thing happened after combined kidney and islet transplantations performed by the same researchers. In the early 1993, a 43-year-old female patient affected with endstage HCV-related cirrhosis underwent observation in our hospital and was subsequently placed on our waiting list for liver transplantation. At the same time, it became evident that she was suffering from a serious form of type 11 diabetes with an impaired endogenous pancreatic function since her C-peptide levels after oral glucose stimulus were less than 1 pg/1. The patient -, , I needed a daily intake of more than 120 units of insulin; yet, a normalization of glycosylated hemoglobin levels was not obtained. In July 1993, liver transplantation was performed in our unit in Padua using an ABO isogroup graft with negative crossmatch following the traditional technique. Organ reperfusion was excellent. At the same time, the donor’s pancreas was sent to Verona where 250,000 islets were isolated and purified according to the technique described by Ricordi et al. [2,7,10]. The islets were then transported to Padua and injected into the recipient through a jejunal vein. They subsequently became diffused throughout the entire vascular bed of the liver graft. In the postoperative period (Fig. l ) , immunosuppression was based on cyclosporin and steroids at the usual dosages. No surgical complications occurred, but a rejection episode on the 5th postoperative day required a steroide pulse and recycle. On the 10th postoperative day, sepsis due to Pseudomonas aeruginosas led the patient to coma with anuria and
Databáze: OpenAIRE
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