From December 1966 to October 1986, 1001 pancreas transplants in 932 diabetic patients were reported to the International Pancreas Transplant Registry. One year actuarial graft function (insulin-independent) and recipient survival rates for all cases were 35% and 75%, respectively. In an analysis by era of 1966-77 (n = 64), 1978-82 (n = 201), 1983-84 (n = 298) and 1985-86 (n = 438) cases, 1 year graft function rates were 3, 21, 39, and 44% and recipient survival rates were 42, 72, 76, and 83, respectively (p less than 0.05 all comparisons, except 1983-84 vs. 1985-86). In an analysis of 1983-1986 cases only (n = 736), the overall 1 year graft function and patient survival rates were 42 and 79%, respectively. During this period, graft functional survival rates were similar (p greater than 0.8) for the most common duct management methods, 43% for duct injection (n = 254), 42% for enteric drainage (n = 254), and 47% for bladder drainage (n = 196) at 1 year. Graft function rates were also similar (p greater than 0.6) for whole (n = 280) and segmental (n = 456) pancreas transplants (41 vs. 42% at 1 year). Functional survival rates according to duration of preservation for grafts stored less than 6 h (n = 460), 6-12 h (n = 146) and greater than or equal to 12 h (n = 52) were 46, 39, and 30% at 1 year, and the difference was significant for the less than 6 vs. the 6-12 h preservation time (p = 0.023). Graft functional survival rates were significantly higher (p less than 0.05) in recipients who received azathioprine (AZA) and cyclosporine (CSA) in combination (n = 408) than in those who received CSA without azathioprine (n = 262) or AZA without cyclosporine, (n = 56), with 1 year graft functional survival rates of 47, 38, and 34%, respectively. For technically successful grafts, the functional survival rates were also significantly higher (p less than 0.05) in recipients treated with CSA + AZA (n = 309) than in those who received CSA without azathioprine (n = 186) or AZA without cyclosporine (n = 44), with 1 year function rates of 63, 53, and 41%, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)

Diabetes Mellitus↗

PubMed1987

Experience with 3, 6, and 24 hours' hypothermic storage of the canine pancreas before islet cell preparation and transplantation.

Canine pancreases underwent cold storage in Collins' solution (CS) or in silica gel-filtered plasma (SGF) for 3, 6, and 24 hours before collagenase digestion and autotransplantation of dispersed pancreatic tissue that contained islet cells to the spleens of totally pancreatectomized dogs. The functional outcome in these animals was compared with animals that received intrasplenically autotransplanted pancreatic islet cell preparations from unstored pancreases. Normoglycemia was restored in 15 of 20 (75%) dogs that received freshly prepared islets. Two of five dogs (40%) whose pancreases were stored in CS for 3 hours became normoglycemic, as did 2 of 5 dogs (40%) whose pancreases were stored for 3 hours in SGF. When 6-hour storage was used only 1 of 5 dogs (20%) whose pancreases were stored in CS and 1 of 5 dogs (20%) in whom SGF was used for storage became normoglycemic. Normoglycemia occurred in only 2 of 16 dogs (12.5%) whose pancreases were stored for 24 hours (one in SGF and one in CS). The results indicate that islet cell preparation should be performed immediately after pancreatectomy. The failure thus far of clinical islet allotransplantation may be due, at least in part, to functional deterioration during preservation of the donor pancrease before isolation of islet cells.

Animals↗

PubMed1987

Pancreas transplant results according to the technique of duct management: bladder versus enteric drainage.

Between July 1978 and February 1987, 177 pancreas transplants were performed. The 1-year patient and graft survival rates for the first 100 transplants up to October 1984 were 88% and 27%, respectively. Since November 1984, duct drainage has been used for 74 of 77 transplants, bladder (BD) in 36 and enteric (ED) in 38, with 1-year patient survival rates of 89% and 92%, respectively, and graft survival rates of 58% and 42%. The technical failure rate was similar in both groups (31%). Immunosuppression was with antilymphocyte globulin, cyclosporine, azathioprine, and prednisone. Most recipients were nonuremic, without kidney transplants, and 1-year graft survival rates were 69% for BD (n = 21) and 42% for ED (n = 29). The diagnosis of rejection was based on a decline in urine amylase activity in the BD and on an increase in plasma glucose alone in the ED group. For technically successful (TS) grafts, the number of rejection episodes reversed per number diagnosed was 23 of 26 (18 patients) in BD (88%) and six of 15 (14 patients) (40%) in ED (p less than 0.05). The advantage of BD with monitoring of urine amylase activity is seen in TS cases; 1-year cadaveric graft survival rates were 90% for BD (n = 23) versus 47% for ED (n = 15) (p = 0.05). In recipients of segmental transplants with ED from living-related donors, 1-year graft survival rates were 57% overall (n = 18) and 88% for TS cases (n = 12), which is identical to cadaveric BD cases. A disadvantage of BD was metabolic acidosis induced by chronic bicarbonate loss in the urine from the pancreas graft. Nevertheless, we conclude that BD is the preferred technique for pancreas transplants from cadaver donors because of the ability to monitor exocrine and endocrine function continuously, thus leading to early diagnosis and treatment of rejection episodes.

Adult↗

PubMed1987