Pancreas transplantation

As a pancreas transplant ( PTx ) is called the operational transfer of the pancreas (pancreatitis ) in an organism.

In general, the combined (simultaneous ) transplantation of pancreas and kidney ( SPK ) an organ donor, whereby the organ recipients on the basis of diabetes mellitus terminal ( final) is niereninsuffizient and is in a dialysis program. The successful PNTX leads to complete normalization of glucose metabolism and dialysis freedom. The chances of success ( 1-year survival rate ) for the PNTX are, according to the International Pancreas Transplant Registry ( IPTR ) at 86 % (pancreas) and 93 % ( kidney). Due to the over the sole renal higher complication are the recipients, strict selected particularly with regard to cardiovascular risk. By the end of 2010, according to data IPTR world's more than 35,000 pancreas transplants, of which 75 % in the U.S. carried out. In Germany the number of pancreas transplants since 2001 is between 212 ( 2001) and 169 (2012 ) per year ( DSO annual reports).

Transplantation by category

  • Combined pancreas - kidney transplantation: Terminal possibly preterminal renal insufficiency type 1 diabetes, in rare cases, type 2 diabetes. Both organs are from the same organ donor and accordingly immunologically identical. The function of the kidney graft serves as an important parameter for the diagnosis of rejection reaction, which is secured by a renal allograft biopsy.
  • Pancreas transplantation after previous kidney transplant ( PAK = pancreas -after- kidney transplant ): The organ recipient was already laid back performed a kidney transplant. The pancreas transplant done so regardless, so both transplanted organs have different tissue characteristics ( HLA markers ). Rejection reactions can always be insulated to run on each of the transplanted organs, the diagnosis in the field of pancreas transplant is difficult due to the lack of sensitive laboratory parameters.
  • Isolated pancreas transplantation ( IPT): Exclusive pancreas transplantation in patients with recurrent severe hypoglycemia and stable renal function. Rejection diagnosis difficult due to lack of sensitive laboratory parameters.
  • Pancreas transplantation as part of a multivisceral transplant, for example, combined with liver or small intestine.

Organ procurement

The organ Agencies are comparable to the kidney according to the criteria of euro transplant. Criteria include, among others, the waiting time and the correspondence of Gewebmerkmale ( HLA characteristics ) of donor and recipient. In addition, further factors such as the country of origin of the donor and recipient as well as the distance between the organ removal and transplantation center in the calculation with.

Living donation

Living donation for pancreas transplantation is possible in principle, however, associated with significant risks for the donor pancreas and significantly poorer results at the receiver.

Surgical Technique

Like hardly any other organ transplantation was the pancreas transplant dominated for long periods of modifications of the surgical technique (see historical development ). As standard equipment, the transplantation of the whole organ, including an approximately 5 -10cm long segment of the duodenum ( duodenum) has been established ( Pankreasduodenaltransplantation ). The Duodenalsegment is the derivative of the pancreatic secretion via an entero-anastomosis to the upper small intestine ( jejunum ) in the small intestine drainage technique or alternatively to the bladder ( bladder drainage technique). The bladder drainage technique ( currently about 15%), however, was increasingly abandoned. The graft is usually intraperitoneally in heterotopic position, not at the site of the pancreas of the recipient, which remains there. In most cases, the graft is in the right lower abdomen. The arteries are anastomosed to the common iliac artery (Beck main artery) and the Transplantatvene ( portal vein ) to the inferior vena cava ( IVC ) or superior mesenteric ( intestinal vein ). The venous anastomosis of intestinal vein is also referred to as a portal venous drainage technology. As practically physiological conditions the action of insulin may be achieved.

Complications

Surgical complications after pancreas transplantation are generally significantly more likely than, say, after an isolated kidney transplant. Graft losses are mostly on the Transplantatvene thrombosis or inflammation of the pancreas transplant ( transplant pancreatitis ) due. The transplant pancreatitis is crucial to understand as a result of the necessary organ preservation ( reperfusion injury ).

Immunosuppression and rejection

Immunosuppressive therapy is basically comparable to for other forms of organ transplantation from a combination of a calcineurin inhibitor (eg cyclosporin or tacrolimus ), a proliferation inhibitor ( mycophenolate mofetil or azathioprine ) and a glucocorticoid (eg, prednisone ). As a rule, antithymocyte globulin (induction therapy) is used initially. Acute Abstoßungsreationen be treated with steroids and antibodies.

Historical Development

The first pancreas transplant was performed as PNTX 1966 by WD Kelly and R. C. Lillehei in Minneapolis (USA). In Germany, the pancreas transplant, especially with Walter country ( pancreatic segment transplantation with Gangokklusion ), UT Hopt ( Pankreasduodenaltransplantation with bladder drainage ) and M. Busing ( small intestine and portal venous drainage) connected.

Swell

  • A.C.Gruessner ( 2011). 2011 Update on Pancreas transplantation: Comprehensive Trend Analysis of 25,000 Cases Followed Up Over the Course of Twenty- Four Years at the International Pancreas Transplant Registry ( IPTR ). Reveau Diabetes Studies 8 (1): 6-16
  • W. D. Kelly, R. C. Lillehei, F.K. Merkel, Y. Idezuki, F. C. Goetz (1967). Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy. Surgery 61 (6): 827-37
  • T.S. Schulz, M. Kapischke, M. Buesing ( 2005). Neoquadruple induction with antithymocyte globulin / azathioprine / cyclosporine / prednisolone in simultaneous pancreas and kidney transplant recipients: 8.5 -year results. Transplant systems Proceedings 37 (4): 1815-7
  • U.T. Hopt, M.Buesing, W. D. Schareck, H. D. Becker ( 1992). The exocrine pancreatic secretion of management - a central problem- of allogeneic pancreas transplantation. The surgeon 63 (3); 186-92
  • M. Buesing, D. Martin, T. Schulz, M. Heimes, J. Klempnauer, W. Kozuschek (1998). Pancreas transplantation with bladder and intestinal drainage technique with systemic - venous and initial experiences with portal venous drainage. Which technique can be recommended today? The surgeon 69 (3): 291-7
  • U.T. Hopt: specific noxious agents in the pathogenesis of transplant pancreatitis in Acute Pancreatitis - transplant pancreatitis, Publisher: UT Hopt, M. Busing, H. D. Becker Publisher Karger, Basel, 1994 ISBN 3-8055-5811-2
  • Pancreas transplantation "Surgical Gastroenterology ", Vol 12, Suppl 1 (1996 ) Publisher: M. Busing, UT Hopt, W. Kozuschek, publisher, Karger, Basel http://idw-online.de/de/news712
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