The dramatic development in clinical organ transplantation has been continued and expanded. Due to the discovery and clinical application of Cyclosporin A--the most potent immunosuppressive drug so far known--the results (1-year-graft survival rate) in the field of kidney, pancreas, liver and heart transplantation have drastically improved. This has led to a remarkable widening of indications for the different types of organ transplantation. The surgical technique of organ transplantation has been solved in kidney, liver, and heart transplantation, but remains to be solved in pancreatic transplantation. The evaluation from the medical-insurance--print of view of this surgical treatment should be restricted to successfully kidney transplanted patients at the time being. It has to be stressed that a success can be assessed only from the 2nd year post-transplant on words. According to considerations on the basis of medical insurance high risk factors have to be distinguished in regard to the transplant (e.g. poor HLA-matching) as well as to the patients (age, secondary diseases, etc.).

Cost-Benefit Analysis↗

PubMed1989

The problem of living organ donation: facts, thoughts, and reflections.

Explore the source record for details and available documents.

Directed Tissue Donation↗

PubMed1989

Metabolic control and effect on secondary complications of diabetes mellitus by pancreatic transplantation.

After successful pancreatic transplantation blood glucose can be normalized without exogenous insulin, although oral and intravenous glucose tolerance remains impaired in 10-45% of the patients. There is no significant deterioration of glucose control with time in most patients. Since most recipients of pancreatic grafts have far advanced secondary diabetic lesions and the observation time after grafting is rather short, the effects of pancreatic transplantation on these complications are difficult to interpret. However, the development of diabetic nephropathy can be prevented, skin microcirculation improves significantly, while autonomic and peripheral neuropathy and diabetic retinopathy remain stable or improve slightly in most patients. But these ameliorations may be in part due to elimination of uraemia, since in almost all patients combined pancreas/kidney transplantations were performed. It is concluded that pancreas grafting probably has to be performed much earlier in the course of diabetes, although the improvement in the quality of life is striking even in the end-stage diabetics studied so far.

Blood Glucose↗

PubMed1989

[Pregnancies in females following kidney and pancreas transplantation].

Uraemic patients are in general infertile. Ovarian function is, however, restored after successful renal transplantation, thus making conception possible. We followed up 14 patients after renal transplantation involving 16 pregnancies. Two patients became pregnant twice, one with twins and the other following renal and pancreatic transplantation--the first recorded in the world. Caesarean section was performed in all patients due to increasing serum creatinin levels, avoid pre-eclampsia or premature rupture of membranes. Both, mother and child in all cases progressed without complications, although these pregnancies are associated with high risk for both. Therefore, a close co-operation between the mother, the nephrologist, the transplantation centre, the gynaecologist and the paediatrician is a prerequisite for a possible favourable course.

Abnormalities, Drug-Induced↗

PubMed1989

Pregnancy after combined pancreas-kidney transplantation.

Four successful cases of pregnancy after combined pancreas-kidney transplantation at four different centers are summarized. The techniques used for the pancreas transplantations were duct obstruction in one patient and enteric exocrine diversion in two patients; in all three patients the insulin delivery was to the systemic circulation. In one patient exocrine diversion was to the stomach and the vascular anastomosis to the splenic vessels, thus accomplishing portal insulin delivery. Immunosuppression consisted of cyclosporin and prednisolone in two patients; cyclosporin alone in one patient; and cyclosporin, azathioprine, and prednisolone in one patient. In all a cesarean section was performed, due to deteriorating renal function in two patients, a fall in fetal growth in one patient, and fear of inducing pancreas-graft pancreatitis during normal delivery in one patient. In all four women, perfect metabolic control was retained throughout the pregnancy, and despite the proximity of the pancreas graft to the growing uterus in three of the women, the pancreas grafts did not suffer any damage during the pregnancy. However, in one patient the pancreas graft was lost in acute rejection after delivery. This pancreas had functioned normally for 3 yr before this occasion. Of the offspring, one was completely normal, one had a bilateral cataract, and two were small for date. The latter two subsequently showed normal growth development. At follow-up at 3, 5, 7, and 28 mo, all kidney grafts and three of the pancreas grafts remained functional. We conclude that after combined pancreas-kidney transplantation, successful conception and pregnancy can be obtained. Despite reduced islet mass (segmental grafts), normal metabolic control can be retained throughout the pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1989