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U T Hopt

Publications and source records attributed to U T Hopt.

At least 127 records · Page 7Linked to original sources
PubMed1992

[The management of exocrine pancreatic secretion--a central problem of allogeneic pancreas transplantation].

In a consecutive series of 47 pancreatic transplantations, the duct occlusion technique and the bladder drainage technique are evaluated. Major problems, when using the duct occlusion technique are pancreatic fistulae with secondary infections and bleedings. Early postoperative graft thrombosis remains a crucial problem. Finally, graft rejection can not be diagnosed in time when using the duct occlusion technique. In contrast, the bladder drainage technique guarantees an absolutely safe management of the exocrine pancreas secretion. The risk of early postoperative graft thromboses reaches nearly zero. In addition, by monitoring urinary amylase and thereby the function of the exocrine pancreas, rejection episodes can be diagnosed very early. Early postoperative graft pancreatitis of the bladder drained pancreatic allografts remains a significant problem. In addition due to excessive bicarbonate loss via the urine oral bicarbonate substitution is necessary. A high incidence of urinary tract infections as well as unspecific irritations of the urinary tract are further drawbacks of the bladder drainage technique. They can be managed, however, relatively easily. Since using the bladder drainage technique, 1-year-graft-function rate of the pancreatic allografts increased by more than 40% and reaches now 88%. The new operative technique represents the best surgical procedure for control of the exocrine secretion of pancreatic allografts at the moment. Simultaneous pancreas-/kidney transplantation in the technique described can therefore be recommended a selected group of type-I diabetics with end-stage renal disease as the therapy of choice.

Adolescent↗
PubMed1992

[Pancreatic transplantation: success and problems].

The results of pancreatic transplantation could be improved markedly since using the bladder drainage technique. The best function rates can be achieved when transplanting simultaneously a kidney from the same donor. In our own series of 50 combined pancreas-/kidney transplantations (CPKT) the 1-year-graft function rate for both organs reaches 88%. The drainage of the exocrine pancreatic secretions into the urinary tract leads, however, to a high incidence of recurrent urinary tract infections. Diagnosis of rejections after combined pancreas-/kidney transplantation is mainly based on the function of the simultaneously transplanted kidney and the exocrine secretion of the pancreatic graft. In spite of triple drug therapy (prednisolone, azathioprine, cyclosporine A) and ATG (antithymocyte globulin) prophylaxis the incidence of acute rejection episodes is initially high. For rejection therapy monoclonal antibodies, such as OKT3, are most effective. Glucose metabolism is almost completely normalized after successful pancreatic transplantation. Considering late diabetic complications, however, only positive effects on diabetic neuropathy are confirmed. This is probably due to the very late onset of therapy by pancreatic transplantation. A significant improvement in other late diabetic complications can only be expected in long term follow up studies. The positive effect on physical and psychological rehabilitation, however, improves the quality of life in most of the patients after CPKT substantially. Even though the results of isolated pancreatic transplantation reaches 1-year-graft function rates of approximately 60% in single centers, the indication to this treatment should consider the disadvantages of long term immunosuppression and the uncertain results considering secondary complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined Modality Therapy↗
PubMed1991

The bladder drainage technique in pancreas transplantation--the Tübingen experience.

Starting in 1987 renal- and pancreaticoduodenal--transplantations were performed simultaneously in a consecutive series of 40 patients with Type 1 diabetes mellitus and end-stage renal disease. Exocrine secretion of the pancreatic graft does not seem to be a crucial problem anymore when using the bladder drainage technique. No pancreatic fistulae were seen. No graft lost its function due to early post-operative graft thrombosis. Early post-operative graft pancreatitis and recurrent urinary tract infections remain the drawbacks of the bladder drainage technique. Despite a strong immunestimulation of the recipient by the combined pancreaticoduodenal/renal allograft all but two rejection episodes could be reversed by using different monoclonal/polyclonal antibodies. Actuarial 1-year-graft survival rate reaches 85% for the pancreas as well as the kidney. Thus, simultaneous pancreas-kidney transplantation can be performed with a high success rate when using the technique described.

Diabetes Mellitus, Type 1↗
PubMed1991

Consequences of systemic venous drainage and denervation of heterotopic pancreatic transplants for insulin/C-peptide profiles in the basal state and after oral glucose.

Plasma glucose, immunoreactive insulin and C-peptide concentrations were compared in nine pancreas-kidney-transplanted patients (systemic venous drainage) and in ten non-diabetic kidney-transplanted patients with similar kidney function. In the basal state, C-peptide (insulin secretion) was similar, but immunoreactive insulin was higher and glucose concentrations were slightly, but significantly lower in pancrease-transplanted patients. After 50 g oral glucose, the plasma glucose and IR-insulin profiles were similar in both groups. The circumvention of first-pass hepatic insulin extraction (decreased endogenous insulin clearance) was compensated for by a significant reduction in insulin secretion (C-peptide; p = 0.036). In conclusion, hyperinsulinaemia in pancreas-transplanted patients with systemic venous drainage is significant only in the basal state. Insulin delivered into the portal and peripheral circulation, when leading to similar insulin profiles, maintains comparable degrees of glucose tolerance.

Blood Glucose↗
PubMed1991

Value of sonography for follow-up examination after allogenic kidney transplantation.

In 66 patients with renal transplants 246 sonographic examinations were performed. The patients were divided into two groups based on their immunosuppressive protocol. Group I was treated with Cyclosporin A (CsA) and group II with azathioprin. A compensatory hypertrophy with a volume increase of 20% could be seen in nearly all grafts. During acute tubular necrosis only minimal sonographic changes could be found. In each group 16 patients developed an acute rejection episode. Sonographic signs of acute rejection were: (1) a hypoechoic enlargement of the renal pyramides; (2) an increase in cortical echogenicity; (3) an increase in graft volume greater than compensatory hypertrophy; (4) an indistinct parenchyma-pelvic border; (5) dilation of the pelvis with a parenchyma-pelvic index greater than 2.3:1 (in group II cases). Chronic rejection is characterized by graft shrinkage. No specific signs were evident. The increasing use of CsA diminishes the value of sonography in follow-up of acute rejection after kidney transplantation. Nevertheless, it is of great value for follow-up examination concerning other complications.

Azathioprine↗