|
Spring 1994Volume 1, Number 1 |
At the Fourth International Congress on Pancreas and Islet Transplantation on June 27-30, 1993, in Amsterdam, the Netherlands, a number of centers from the United States and Europe reported significantly better graft survival rates than in the past for patients undergoing vascularized pancreas transplantation. In selected centers (eg, Wisconsin, Nebraska, Ohio State), one-year graft survival rates are between 85% and 90% with the vascularized procedure.
The majority of centers worldwide continue to use whole organ transplantation with pancreaticoduodenocystostomy, a vascularized procedure. The Stockholm group, however, describing their latest results with enteric exocrine drainage in 18 patients, reported a one-year patient survival of 94% and a graft survival of 83%. This method of enteric drainage utilizes a side-to-side anastomosis of the ileum to the duodenal segment. The use of an intraductal catheter has been abandoned.
The donor impact on outcome of the procedure was analyzed by Gruessner from the Minnesota group, who found a significantly higher risk of failure if the donor age was above 50 years and if the donor serum glucose was above 200 mg/dL.
Several groups described the impact of pancreas transplantation on secondary diabetic complications. There was agreement that neuropathy improves, as demonstrated by objective measures such as nerve conduction velocity and gastric emptying rate. Dr. Anthony Cheung from Sacramento, California, presented his experience with microangiopathy in patients receiving successful simultaneous pancreas-kidney transplants. Using computer-assisted intravital microscopy, he studied capillary leakage after the injection of sodium fluorescein. His data demonstrated that microangiopathy reversal in type I diabetes was directly related to the pancreas and not the kidney transplant. Abendroth from the Munich group demonstrated that microcirculation is improved after simultaneous pancreas-kidney transplantation; however, fibrinogen levels and the shear rates (a measure of the force with which platelets adhere to each other) are increased, indicating a persistent vascular risk for these patients. The effect of pancreas transplantation on diabetic retinopathy was investigated by the Milan group. They concluded that pancreas transplantation has no significant impact on diabetic retinopathy. It was their impression that diabetic retinopathy is far too advanced at the time of the procedure to benefit from the improved glycemic control achieved after pancreas transplantation. In contrast, Sollinger from the Wisconsin group reported significant improvement in retinopathy in 26% of patients as measured by fluorescein angiography.
Several papers addressed improved lipid control after simultaneous pancreas-kidney transplantation. Furthermore, the improvement in quality of life was emphasized by Zehr from the Minnesota group, Hathaway from the Memphis group, Nakache from the Stockholm group, and Kiebert from Leiden, the Netherlands. In the field of islet transplantation, the great disappointment was the report by the Edmonton group that their long-term patient (2.5 years after kidney-islet transplantation) ceased to have islet function. Similarly, the two longest-functioning patients from the Minneapolis group (6 and 12 months) also had a sudden deterioration of islet function. Many investigators reported on improved techniques for islet isolation and preservation. In addition, a variety of encapsulation techniques were presented with the most promising results coming from Dr. Patrick Soon-Shiong's laboratory demonstrating long-term function of encapsulated islets in dogs.
Hans Sollinger, MD, PhD
University of Wisconsin School of Medicine
Madison, Wisconsin
Please be aware that medical advice, diagnoses and physician references cannot be obtained from this site.