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At least 73 records · Page 4Linked to original sources
PubMed2006

CT differentiation of distal pancreas fat replacement and distal pancreas agenesis.

We aimed to describe CT signs useful for differentiation of distal agenesis from distal or dorsal pancreas lipomatosis. Multidetector CT (MDCT) studies of five patients with distal pancreas agenesis (n = 2), distal lipomatosis (n = 1), distal short pancreas (n = 1), and distal pancreatectomy (n = 1) were retrospectively reviewed. Agenesis of dorsal pancreas can be diagnosed by the absence of body and tail of pancreas. In the absence of distal pancreas, distal pancreatic bed can be filled by stomach or intestine (dependent stomach or dependent intestine signs), which abut splenic vein. Same findings can be seen in patients with distal pancreatectomy, however, splenic vein is absent in these patients. In case of distal lipomatosis abundant fat tissue is observed anterior to splenic vein. Dependent stomach and/or dependent intestine signs on MDCT imaging can allow differentiation of distal pancreas agenesis from distal lipomatosis obviating further diagnostic studies.

Adipose Tissue↗
PubMed1985

[Effect of a specific serine protease inhibitor on the rat pancreas. II. Influence of camostate on the endocrine pancreas].

Chronic oral administration of camostate, a specific serine protease inhibitor, is known to induce pancreas hypertrophy in rats. A possible influence of the protease inhibitor on the endocrine rat pancreas was studied using isolated perfused pancreas and islet incubations. The presence of camostate had no direct effect on the glucose-induced insulin release in vitro in concentrations from 1 microM to 1 mM, but enhanced the basal insulin release from islets cultured over 24 h in media containing the protease inhibitor (100 microM). Administration of camostate over 14 days to rats induced a remarkable hypertrophy of the pancreas without influencing plasma insulin or gastric inhibitory polypeptide levels and insulin concentration of the pancreas. Glucose-stimulated insulin release from the perfused pancreas was not increased despite significantly higher total insulin content. It is concluded that camostate exerts no direct effect on the glucose-stimulated insulin release and that chronic administration of the compound induces pancreas hypertrophy in vivo without influencing insulin release.

Administration, Oral↗
PubMed2006

[Bilobular pancreas: another variant of the divided pancreas?].

BACKGROUND: Pancreas divisum is the most common anomaly of the pancreas. This anomaly has been known as a possible cause of recurrent pancreatitis. CASE REPORT: We performed computerized tomography (CT) of the abdomen in 5 children in whom a divided pancreas was confirmed using endoscopic cholangiopancreatography. In a girl, who had three episodes of severe acute pancreatitis, a CT examination confirmed a completely divided embryonal dorsal and ventral primordium. We named this variant of the divided pancreas the "bilobular pancreas". Contrary to the remaining 4 children in whom the control of the number and severity of attacks, as well as the control of pancreatic pain were achieved by pharmacotherapeutics and an adequate diet, in the reported patient sphincteroplasty of the papilla duodeni minor resulted in a full control of the disease. CONCLUSION: The paper discussed the possibility that the variant of the divided pancreas, with anatomically completely separated ventral and dorsal pancreas and their ductal systems, is the key factor that determines the severity of pancreatic disease and an indication for sphincteroplasty of the papilla duodeni minor as the major therapeutic method.

Acute Disease↗
PubMed2003

[The impact of morphologic and physiologic peculiarities of the pancreas on pancreas-related complications following pancreatoduodenectomy].

BACKGROUND: The factors influencing failure of pancreaticojejunostomy following pancreatoduodenectomy are still ill-defined. Our previous study showed that age of patient, bilirubinemia or malignant nature of peripancreatic tumor had no impact on pancreas-related morbidity following pancreatoduodenectomy. The hypothesis is that it could be influenced by the level of pancreatic fibrosis, diameter of the main pancreatic duct, and exocrine pancreatic function. Aim of the study was to analyze the impact of morphologic and physiologic peculiarities of pancreatic remnant on development of pancreas-related morbidity after Whipple procedure. MATERIAL AND METHODS: We have analyzed retrospectively clinical data of 122 patients who have undergone pancreatoduodenectomy in the Department of Surgery of Kaunas University of Medicine Hospital during 1995-2001. Fibrosis of pancreatic parenchyma, diameter of main pancreatic duct, and preoperative exocrine function were evaluated. Pancreas-related morbidity was determined as either peripancreatic sepsis or pancreatic fistula. Fibrosis of pancreatic remnant was determined by computer-aided morphometric analysis. The exocrine pancreatic function was tested the day before surgery by Pancreatic Elastase-1 Stool test. RESULTS: One hundred twenty two patients have undergone pancreatoduodenectomy during 1995-2001. Pancreas-related morbidity was encountered in 27 (22.13%) cases, pancreatic fistula in 13 (10.65%) and peripancreatic sepsis in 14 (11.47%). Univariate analysis shows that diameter of main pancreatic duct and level of postoperative amylasemia were significantly different between the groups with and without pancreatic complications (p=0.001 and p=0.002, respectively) as well as there was significant difference of pancreatic exocrine function and fibrosis between the groups of patients who developed pancreas-related complications and who did not (p=0.003 and p=0.026, respectively). When logistic regression analysis was applied on those 4 variables, only one independent risk factor - exocrine pancreatic function at the cut-off of stool Elastase 100 micro g/g was revealed (odds ratio 21.6). The sensitivity of the Stool Elastase-1 test was 0.86, specificity 0.78, positive predictive value - 0.55 and negative predictive value - 0.95. CONCLUSIONS: The level of pancreatic fibrosis, diameter of the main pancreatic duct, and exocrine pancreatic function mainly influence pancreas-related morbidity following pancreatoduodenectomy. Exocrine pancreatic function measured by Stool Elastase-1 test is helpful for the detection of the group of patients with minimal risk for pancreas-related morbidity after pancreatoduodenectomy.

Data Interpretation, Statistical↗
PubMed1985

[Experimental studies on regeneration of the pancreas--morphological and functional restoration of the remnant pancreas after major pancreatectomy].

In order to elucidate a regeneration of the pancreas, morphological and functional changes after major pancreatic resection were sequentially investigated in dogs. Within the first week after major pancreatectomy, the acinar cell division occurred, followed by hypertrophy resulting in an increase of the weight of the remnant pancreas. The regeneration rate correlated with the resection rate, glucose tolerance test, and insulin secretion of the remnant pancreas. Immediately after resection of more than 92% of the pancreas, severe diabetes and diarrhea developed. The regeneration rate was 29.9 +/- 6.03% (mean +/- SD) three to six weeks after surgery, without any recovery of the exocrine function. After twelve weeks following resection of 74 to 92% of the pancreas, so-called Sandmeyer's diabetes developed. The regeneration rate was 45.3 +/- 4.22% in the nondiabetic group, accompanied with a good recovery of the exocrine function, but in the diabetic group it revealed regeneration rate of 15.4 +/- 2.39% with less recovery of the exocrine function. When less than 74% of the pancreas was resected, no significant changes were observed in both morphological and functional studies in the remnant pancreas with regeneration rate of 5.5 +/- 6.62%.

Amylases↗
PubMedDate not supplied

Ductal morphometry of ventral pancreas in pancreas divisum. Comparison between clinical and anatomical results.

Aim of the investigation is to precisely study the morphological features of ventral pancreas ductography in pancreas divisum, in order to improve the radiological interpretation and differential diagnosis of this frequent pancreatic anomaly. The clinical part of the study was based on 610 endoscopic retrograde pancreatograms, with pancreas divisum diagnosed in 14 (2.3%) cases; while the anatomical part consisted of 203 postmortem pancreatograms of human pancreas obtained at autopsy, where pancreas divisum was found in 12 (5.9%) cases. The following ductal features of the ventral pancreas were studied: length and calibre of the main duct, number of side branches, calibre of the common bile duct and the biliopancreatic junction angle. No significant differences were detected between the results from the 2 groups, with the exception of side branches, which were more numerous in the anatomical series, probably because of higher injection pressure and consequent better opacification. These results underline the potential of the anatomical pancreatography serving as a model for studying the ductal system of pancreas divisum.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1995

Pancreas transplantation in the United States as reported to the United Network for Organ Sharing (UNOS) and analyzed by the International Pancreas Transplant Registry.

As of 1995, more than 7,500 pancreas transplants had been reported to the International Pancreas Transplant Registry. More than 5,300 were performed in the United States, including more than 4,000 since the inception of the UNOS Registry in October, 1987. The bladder drainage (BD) technique has been the most widely used duct management technique since 1987 with 93% of all cases. In the overall analysis of US BID cadaveric pancreas transplants reported to the registry, patient survival and pancreas functional graft survival rates were 91% and 75% respectively, at one year, 88% and 72% at 2 years, and 85% and 67% at 3 years. When the 1987-95 US data for primary BID cases was analyzed according to the three major recipient categories [simultaneous pancreas/kidney transplants (SPK) (n=3,539); pancreas after kidney transplants (PAK) (n=238); and pancreas transplants alone (PTA) (n=175)], patient survival rates were no different (91%, 92% and 91% at one year, respectively), but pancreas graft survival rates were significantly higher in the SPK than in the PAK and PTA categories (78%, 56%, and 55%, at one year, respectively). In the SPK group, kidney graft survival rates at one year were 86%. An improvement of the graft survival could be shown over the analyzed time period for all categories. Outcomes were also compared according to whether induction immunotherapy in recipients included ALG/ATG/ATS, OKT3 or neither. In the primary SPK category, patients who received OKT3 (n=1,416) showed the best outcome with one-year graft survival rates of 83% followed by ALG/ATG/ATS (n=1,559) with 78%. Patients that received neither (n=410) had a significantly lower graft survival rate. In the primary PAK category, the use of OKT3 (n=49) was associated with lower graft survival rates than when ALG/ATG/ATS (n=143) or neither (n=40) were given, 51%, 66%, and 55% at one-year, respectively. In the PTA category, the use of ALG/ATG/ATS (n=93) was associated with significantly higher graft survival rates than when OKT3 (n=62) or neither (n=9) were used, being 63%, 58%, and none, respectively, at one-year. No negative impact of longer preservation time could be found in the univariate analysis. The effect of HLA-A, B and DR mismatching on outcome for primary US cases was also determined. Again the results differed according to recipient category. For SPK cases, there was only a beneficial effect of a perfect 6 antigen match (n=21) compared to 1 and 2-6 mismatches being 85%, 73% and 78% at one-year. In the primary PAK category, graft survival rates were significantly higher in those mismatched for 0 (n=6) and one (n=25) than for 2-6 (n=195) HLA antigens, being 100%, 76% and 58% at one year. In the primary PTA category there were no zero mismatch, technically successful cases. One-year graft survival rates were 70% (n=10) for the category with one mismatch and 55% (n=157) in the 2-6 antigen mismatch group. Cox multivariate analyses of the US data base showed that, overall, recipient category was the most significant factor (relative risk for graft loss being significantly lower for SPK than for PAK and PTA cases). Other variables also had an impact on results depending on the recipient category. Recipient age has an impact on patient survival as well as graft survival. It was most influential in the SPK and PAK category, but an effect was not seen in the PTA category. In both the PAK and PTA categories, minimizing HLA mismatches was associated with a significantly lower risk for graft loss. In the SPK and PTA category, anti-T-cell therapy significantly lowered the risk of graft loss. In the PAK and SPK category the transplant outcome improved significantly over the analyzed time period. Patient survival also improved overtime.

Adult↗
PubMed2006

Multidetector CT of pancreas: effects of contrast material flow rate and individualized scan delay on enhancement of pancreas and tumor contrast.

PURPOSE: To prospectively assess whether high contrast material flow rate (8 mL/sec) and individualized scan delay improve enhancement of normal pancreas with multidetector computed tomography (CT) and, as a result, tumor-to-pancreas contrast of pancreatic adenocarcinoma. MATERIALS AND METHODS: Informed consent was obtained in 40 patients (21 women, 19 men; mean age, 67.1 years); the institutional review board approved this protocol. Patients were referred for multidetector CT because they were suspected of having a pancreatic tumor and were randomized to receive 150 mL of nonionic contrast material (300 mg of iodine per milliliter) at a flow rate of 4 mL/sec (n = 21) or 8 mL/sec (n = 19). Patients underwent dynamic scanning at one level every 2 seconds for 66 seconds after intravenous administration of contrast material. Contrast enhancement of pancreas and tumors was measured with circular regions of interest (analysis of variance and Bonferroni-Holm corrected post hoc t tests). RESULTS: Peak contrast enhancement in pancreas was observed significantly earlier (mean +/- standard deviation, 28.7 seconds +/- 3.5 vs 48.2 seconds +/- 5.3; P < .05) and was significantly higher (129.0 HU +/- 25.7 vs 106.2 HU +/- 35.4, P < .05) with a flow rate of 8 mL/sec than with a flow rate of 4 mL/sec. Tumor-to-pancreas contrast greater than 40 HU lasted significantly longer with a flow rate of 8 mL/sec than with a flow rate of 4 mL/sec (26.4 seconds +/- 11.9 vs 8.6 seconds +/- 8.3, P < .05). With a flow rate of 8 mL/sec, an individualized scan delay of 19 seconds after aortic transit time revealed higher tumor-to-pancreas contrast than did a fixed scan delay, and tumor conspicuity was better. CONCLUSION: With 16-section CT, increased contrast material flow rate of 8 mL/sec and individualized scan delay were associated with improved pancreatic enhancement and tumor-to-pancreas contrast compared with flow rate of 4 mL/sec and fixed scan delay.

Adenocarcinoma↗
PubMed2002

Intraductal papillary-mucinous tumor of the pancreas concomitant with ductal carcinoma of the pancreas.

BACKGROUND: Despite the recent progress of diagnostic and therapeutic modalities, the clinical course of patients with ductal carcinoma (DC) of the pancreas remains dismal. Intraductal papillary-mucinous tumor of the pancreas (IPMT) is sometimes accompanied by malignant diseases of the other organs and pancreatic adenocarcinoma. Thus, IPMT may be a potential diagnostic clue to DC of the pancreas at early phase. METHODS: Clinicopathologic findings of 7 Japanese patients with IPMT of the pancreas concomitant with independent DC were examined and compared with those of 69 patients with IPMT alone and of 70 with DC alone. RESULTS: The seven patients corresponded to 9.2% of 76 patients with IPMT and 9.1% of 77 patients with DC. The seven male patients ranged from 55 to 75 years with a mean of 64.3. DC was synchronous with IPMT in five patients, metachronous to IPMT (4 years after IPMT) in one, and synchronous with IPMT and metachronous to IPMT and DC (7 years after IPMT) in the other. In 4 patients, the presence of IPMT led to the diagnosis of DC. All the 7 IPMTs were of branch type with a mean diameter of 3.0 cm. The IPMT was located in the head of the pancreas in 3, body in 2 and tail in the other 2. All the 7 IPMTs were adenoma with mild dysplasia. Two of the 7 patients with DC had in situ carcinoma, 1 minimally invasive carcinoma and the remaining 4 invasive carcinoma. The mean diameter of seven DCs (3.0 cm) with IPMT were smaller than that of 70 DCs (3.6 cm) (8P = 0.0295). Stage (stage I/II/III/IV = 3/0/3/1) of the seven DCs concomitant with IPMT were significantly earlier than that (stage I/II/III/IV = 5/6/28/31) of the other 70 (p = 0.0203). The survival curve of the 7 patients with IPMT and DC was significantly better than that of the 70 with DC alone (p = 0.0460). CONCLUSIONS: Clinicians should pay attention to the possible presence of DC of the pancreas in male patients with intraductal papillary-mucinous adenoma of the pancreas of branch type in their 6th to 8th decades.

Adenocarcinoma, Mucinous↗
PubMed2000

Insulin-like growth factor II in human fetal pancreas and its co-localization with the major islet hormones: comparison with adult pancreas.

Insulin-like growth factor II (IGF-II) appears to play an important role during fetal life in cell growth and differentiation in several organs, including the pancreas. In the present study we investigated the cellular localization of IGF-II in human fetal pancreas at 16, 18 and 22 embryonic weeks and compared it with adult pancreas. Single and double immunofluorescence methods were used to study co-localization of IGF-II with the four major islet hormones - insulin, glucagon, somatostatin, pancreatic polypeptide - and with islet amyloid polypeptide (IAPP). Distinct IGF-II immunoreactive (IR) cells were found in the endocrine, but not in the exocrine, pancreas. The intensity of IGF-II immunoreactivity was more pronounced in the fetal than in the adult pancreas. In fetal pancreas IGF-II immunoreactivity was observed in virtually all insulin-IR cells and in subsets of the glucagon, somatostatin and IAPP cells. In the adult pancreas, IGF-II immunoreactivity was found in insulin/IAPP cells only. Our results suggest a broader effect of IGF-II in fetal endocrine pancreatic cells than in the adult.

Adult↗
PubMed1991

[Hepatic arterial infusion chemotherapy and loco-regional treatment and irradiation of pancreas tumor in non-resectable pancreas cancer with liver metastases].

This study seeks to evaluate arterial infusion chemotherapy and radiotherapy for non-resectable pancreatic cancer with liver metastases. Arterial infusion to the liver was performed in 24 patients, 15 of whom received arterial infusion to the pancreas and 9 of whom underwent irradiation for pancreas tumor (40-50 Gy). However, arterial infusion to the liver alone did not prolong survival, but loco-lesional therapy for the pancreas tumor improved quality of life and resulted in good local control. The survival of the two treatment groups (arterial infusion to the liver combined with loco-regional treatment to the pancreas versus systemic chemotherapy) was statistically different (median 7 months versus 3 months, p less than 0.01). Arterial infusion to the pancreas decreased liver metastases as the first site of failure. These results suggested that arterial infusion to both liver and pancreas combined with irradiation for the pancreas tumor are effective in increasing survival time and improving the quality of life.

Administration, Oral↗
PubMed1980

Reversal of the enhanced somatostatin release from the isolated, perfused diabetic rat pancreas after the amelioration of diabetes by whole pancreas transplantation.

To investigate the pancreatic endocrine function in streptozotocin-diabetic rats before and after the whole pancreas was transplanted, pancreatic insulin, glucagon, and somatostatin content and release were measured. Highly inbred Lewis male rats were divided into the following three groups: normal control rats; streptozotocin-induced-diabetic rats; and streptozotocin-diabetic rats transplanted with whole pancreas. Studies in vivo revealed normalization of elevated blood glucose and marked improvement of the impaired arginine-induced plasma insulin release by the transplantation of a healthy pancreas into the diabetic rats. Neither basal nor arginine-induced plasma glucagon levels in the diabetic rats were significantly different from the normal group, but significantly higher plasma glucagon levels were found in the transplanted rats. Studies in vitro using the isolated perfused rat pancreas revealed a significant increase of somatostatin release from the diabetic pancreas, with a marked reduction of insulin release and almost normal glucagon release. In the transplanted rats, on the other hand, arginine-induced somatostatin release from the host pancreas was reduced to normal without a significant change in insulin or glucagon release. In addition, the endocrine function of the graft remained normal in the transplanted rats. Pancreatic somatostatin release, thus, appears to be effected by changes in circulating insulin, since pancreatic transplantation effectively corrects the circulating insulin level.

Animals↗
PubMed2000

Mammalian deoxyribonucleases I are classified into three types: pancreas, parotid, and pancreas-parotid (mixed), based on differences in their tissue concentrations.

Deoxyribonuclease I (DNase I) activities were measured in 14 different tissues from humans and 5 other mammals (bovine, pig, rabbit, rat, and mouse) by using the single radial enzyme diffusion (SRED) method, which is a sensitive and nonradioactive assay for nucleases. The results indicated that these species are classifiable into three groups on the basis of their different tissue distributions of DNase I. In human and pig, the pancreas showed the highest activity of DNase I; in rat and mouse, the parotid glands showed the highest activity; and in bovine and rabbit, both pancreas and parotid glands showed high activity. Therefore we designated human and pig DNase I as pancreas type, rat and mouse DNase I as parotid type, and bovine and rabbit DNase I as pancreas-parotid (or mixed) type. DNase I of the pancreas type was more sensitive to low pH than the other types. DNase I of pancreas type is secreted into the intestinal tract under neutral pH conditions, whereas the other types are secreted from the parotid gland and have to pass through the very acidic conditions in the stomach. Differences in the tissue distribution and acid sensitivity of mammalian DNases I may provide important information about their digestive function from the evolutionary perspective.

Acids↗
PubMed2001

Solid and papillary tumor of the pancreas complicating agenesis of the dorsal pancreas.

We report the first documented case of a solid and papillary tumor of the pancreas (SPT) complicating agenesis of the dorsal pancreas. A 28-year-old female patient was referred to our hospital for a pancreatic tumor detected at a local hospital. The laboratory findings were all within normal limits. Diagnostic images revealed absence of the dorsal pancreas and the presence of a tumor located in the head of the pancreas. The tumor was solid, well demarcated, noncalcified, and hypovascular. Fine-needle aspiration cytology revealed that larger cell clumps often had a branching papillary appearance, with multiple layers of tumor cells surrounding central vascular stalks; a preoperative diagnosis of SPT was made. At surgery, on February 10, 1999, the tumor was found to have clear margins, and it showed no signs of direct invasion of adjacent structures. No metastases were found in the liver or the local lymph nodes. Accordingly, partial resection of the pancreas, including the entire tumor, was performed, and, thus, almost the entire head of the pancreas could be saved. Microscopic examination of the resected specimen yielded findings compatible with SPT. No recurrences, and no impairment of pancreatic endocrine or exocrine function have been noted since the operation.

Adult↗
PubMed2006

Analyses of pancreas development by generation of gfp transgenic zebrafish using an exocrine pancreas-specific elastaseA gene promoter.

In contrast to what we know on development of endocrine pancreas, the formation of exocrine pancreas remains poorly understood. To create an animal model that allows observation of exocrine cell differentiation, proliferation, and morphogenesis in living animals, we used the zebrafish elastaseA (elaA) regulatory sequence to develop transgenic zebrafish that display highly specific exocrine pancreas expression of GFP in both larvae and adult. By following GFP expression, we found that the pancreas in early development was a relatively compact organ and later extended posterior along the intestine. By transferring the elaA:gfp transgene into slow muscle omitted mutant that is deficient in receiving Hedgehog signals, we further showed that Hedgehog signaling is required for exocrine morphogenesis but not for cell differentiation. We also applied the morpholino knockdown and toxin-mediated cell ablation approaches to this transgenic line. We showed that the development of exocrine pancreas is Islet-1 dependent. Injection of the diphtheria toxin A (DTA) construct under the elastaseA promoter resulted in selective ablation of exocrine cells while the endocrine cells and other endodermal derivatives (liver and intestine) were not affected. Thus, our works demonstrated the new transgenic line provided a useful experimental tool in analyzing exocrine pancreas development.

Amino Acid Sequence↗
PubMed1992

Surgical complications in solitary pancreas and combined pancreas-kidney transplantations.

The benefits of pancreas transplantation (PT) must be weighed against the morbidity associated with the operative procedure and long-term immunosuppression. Over a 32-month period, we performed 73 PTs including 61 combined pancreas-kidney transplants (PKT) and 12 solitary PTs. In the PKT group, 25 reoperations were performed in 18 patients (29.5%) at a mean of 39 +/- 12 days after transplant. In the solitary PT group, 16 reoperations were performed in 8 recipients (66.7%, p = 0.03) at a mean of 87 +/- 12 days after PT (p < 0.01). In the PKT group, pancreas allograft survival was 93.4%. Vascular thrombosis resulted in the loss of two pancreas allografts. In the solitary PT group, pancreas allograft survival was 50% (p < 0.001), with 6 transplant pancreatectomies performed for either infectious (5) or vascular (1) complications. Surgical complications after PT are common (35.6% in this series), occur earlier in patients who undergo PKT, and are more frequent and morbid in patients undergoing solitary PT, especially after a previous kidney transplant. An aggressive surgical approach can lead to a high rate of pancreas allograft salvage without jeopardizing either the patient or the renal allograft.

Adult↗
PubMed1995

Multivariate analysis of donor risk factors for pancreas allograft failure after simultaneous pancreas-kidney transplantation.

BACKGROUND: Donor and recipient selection criteria for pancreas allograft are not standardized and may vary from center to center. METHODS: Simultaneous pancreas-kidney transplantations performed between April 1988 and June 1994 were reviewed (n = 61), and univariate and multivariate analyses of factors that affect pancreas graft survival were performed. Analysis of all cases and cases excluding early thrombosis were performed separately. RESULTS: Pancreas graft survival when early thrombosis was excluded and in the overall group was 76% and 70%, respectively, at 1 year. Although blood group and donor gender were weak predictors of graft survival by univariate analysis, neither affected graft survival in the multivariate model. Risk factors for graft failure as determined by Cox regression analysis and in descending order of significance were (1) duration of brain death before procurement, (2) length of donor admission, and (3) donor age of 40 years or older. The risk of graft failure for each of these factors was increased 2.2-, 3.2-, and 4-fold, respectively. Prolonged brain death was the only risk factor in the overall group, suggesting an association with early thrombosis. CONCLUSIONS: Center-specific donor risk factors for pancreas graft survival after simultaneous pancreas-kidney transplantation were identified in this study, the importance of which need to be better defined.

Adult↗
PubMed1997

Living related donor pancreas and pancreas-kidney transplantation.

Our experience with living related donor (LRD) pancreas transplants shows that they can be performed with low morbidity and mortality for both donors and recipients. The recipient survival rate is 90% at both 1 and 5 years post-transplant. Our overall pancreas graft survival rate is comparable to that for cadaver transplants; if only technically successful cases are included, the graft survival rate is significantly better for LRD (versus cadaver) transplants. Advantages for LRD recipients include fewer rejection episodes, less immunosuppression, lower incidence of graft loss from rejection, and elimination of waiting time. Donor mortality in our series was 0%, and the incidence of surgical complications about 10-15%. LRD pancreas transplants are an attractive option for endocrine replacement therapy in certain diabetic patients. Optimal candidates are: (i) patients who are highly sensitized and have a low probability of receiving a cadaver graft; (ii) patients who should avoid high-dose immunosuppression; (iii) patients with nondiabetic identical twins; and (iv) uremic patients who want one operation with no waiting in order to remain or become dialysis free as well as insulin-independent. These transplants can be performed safely in all recipient categories--pancreas transplant alone, pancreas after kidney or simultaneous pancreas-kidney transplant. In all groups, LRD transplants should be done only when the donor, the recipient, and the entire family understands the advantages and disadvantages of LRD versus cadaver transplants.

Decision Making↗