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PubMed1991

Blood group and blood-group-related antigens in normal pancreas and pancreas cancer: enhanced expression of precursor type 1, Tn and sialyl-Tn in pancreas cancer.

Expression of blood-group antigens A, B, Le(a), sialyl-Le(a) (sLe(a)), Le(b), Le(x), Le(y), precursor type I, Tn and sialyl-Tn (sTn) was examined in non-neoplastic pancreas (n = 37) and pancreas cancer (n = 21) using mouse monoclonal antibodies (MAbs). Immunohistochemical assays were performed on sections of paraffin-embedded tissues using the avidin-biotin complex method. In normal pancreas, antibodies detecting Le(a), sLe(a) and Tn reacted with ductal epithelium, and antibodies detecting A and B reacted with acini and ducts, independently of secretor status. Le(x) was weakly expressed in ducts and acini, and sTn could not be detected in normal pancreas. Expression of Le(b), Le(y) and precursor type I was regulated by secretor status: Le(b) and Le(y) were expressed in ducts of secretor and Le(a-b-) individuals, but not in ducts of non-secretors; precursor type I was weakly expressed in acini and ducts of non-secretors and Le(a-b-) individuals, and was absent in acini and ducts of secretors. The following alterations in the expression of blood-group antigens were observed in pancreas cancer: (1) enhanced expression of Le(x), Tn and sTn; (2) enhanced expression of precursor type I independently of secretor status; (3) loss of regulation of Le(b) by the secretor gene; (4) decreased expression of Le(y). The weak expression of precursor type I. Tn and sTn in non-neoplastic pancreas, and their stronger expression in pancreas cancer, suggests that up-regulation of their expression is associated with malignant transformation of pancreatic duct cells.

ABO Blood-Group System↗
PubMed1993

Intermediate filaments as differentiation markers of exocrine pancreas. II. Expression of cytokeratins of complex and stratified epithelia in normal pancreas and in pancreas cancer.

Cytokeratin (CK) expression in tumors generally reflects the CK pattern of the corresponding normal epithelium. Pancreas cancers express CK of simple epithelia 7, 8, 18 and 19, as normal ductal cells. To analyze whether CK of complex or stratified epithelia are abnormally expressed in pancreas cancers, we have used polypeptide-specific mouse monoclonal antibodies (MAbs) detecting CK 5, CK 10, CK 13, CK 14 and CK 17, and an antibody detecting CK 13, CK 15 and CK 16. The streptavidin-peroxidase technique was applied on sections of fresh-frozen specimens of normal pancreas and of pancreas cancer. None of these polypeptides were expressed by normal acinar and centro-acinar cells. CK 5, CK 14 and CK 17 were expressed by less than 5% of cells in normal ducts, whereas CK 10, CK 13, CK 15 and CK 16 were not expressed at all. In tumors, CK 14, CK 15/16 and CK 17 were detected in the majority of cases studied; CK 5, CK 10 and CK 13 were present in a sub-population of pancreas cancers. CK of complex/stratified epithelia were detected in areas of glandular differentiation, but expression was more intense in areas of squamous differentiation. In pancreatitis adjacent to cancer, CK of complex/stratified epithelia were weakly detected or undetectable. These results suggest that up-regulation of these CK takes place in pancreas cancer. The CK phenotype may be of help in the differential diagnosis of this tumor.

Antibodies, Monoclonal↗
PubMedDate not supplied

[Pancreas transplantation in dogs, effect on the endocrine pancreas of pancreatic duct obliteration and the mode of pancreas preservation. Histological study by surface analysis in dogs].

The effects of organ preservation and of canal obliteration on the endocrine pancreas were investigated in three groups of dogs. A control group of 6 animals were used for the histological examination of the normal pancreas. Two randomized groups (A and B) of 7 dogs the caudal pancreas was autotransplanted; a fibrin glue was injected into the pancreas canals 28 days before organ removal. In the group A, each graft was rinsed in a Euro-Collins solution and immediately transplanted. In group B, each graft was rinsed and held in a preservation solution for 24 hours before transplantation. On histological slices the ratio between of the total surface area of Langerhans islets to the mean surface area of each islet was greater in the control group than in group A (p = 0.011 and 0.023); the ratio was not significantly different between the control group and the group B (p = 0.334 and 0.099). The histological surface area study suggested that the mode of organ preservation affects the endocrine pancreas and that blocking the canals has little effect.

Animals↗
PubMed1996

Comparison before and after transplantation of pancreas-kidney and pancreas-kidney with loss of pancreas--a prospective controlled quality of life study.

The aim of combined pancreas-kidney transplantation (PKT) in type I diabetic patients with end-stage nephropathy is to restore both functions. Quality of life (QoL) is supposed to improve as a result of this combined transplantation. The objectives of this study are to evaluate QoL before and after PKT and to compare the results with patients in whom the pancreas graft failed soon after the transplantation (PKT-P). The trial is a prospective controlled multicenter study. The control group consists of patients before transplantation and patients who received a PKT in whom the pancreas rejected or thrombosed soon after the transplantation. (PKT-P). A standardized home-based interview is done during dialysis, and repeated 5, 12, and 18 months after transplantation in both groups by the same interviewer. The interview consisted of disease-specific questions (RSCL), general questionnaires (NHP I and II, ABS), the Visual Analogue Scale, a specific questionnaire (Anxiety), and evaluative questions about social support and transplantation. Patients in whom the PKT is successful (n=17) improve significantly or show a strong tendency toward improvement on many aspects of quality of life. Patients in whom the pancreas failed (n=5) still demonstrate improvement, although this is not statistically significant in most cases. Intergroup comparison shows that PKT patients are less anxious, suffer of less itching, have better average daily living conditions, have no diet restrictions, and have a better [correction of have and] global quality of life.

Adult↗
PubMed1978

[The anatomical and histological investigation of the pancreas in the 19th century and till the discovery of insulin (1921). 1. The anatomical pancreas research from the beginning till the discovery of islets of pancreas (1869) (author's transl)].

In this investigated period are the vessels of pancreas exactly described. Further on are in the first half of the 19th century comparative-anatomical and embryological studies on pancreas carried out. The physiology and function of pancreas are also in this time investigated. The enzymatic digestion of succus pancreaticus is discovered. RUDOLF VIRCHOW has 1854 the internal secretion of pancreas postulated.

Anatomy↗
PubMed1978

[The anatomical and histological investigation of the pancreas in the 19th century and till the discovery of insulin (1921). 2. The pancreas research from the discovery of islets (1869) till the discovery of pancreas-diabetes (1889) (author's transl)].

In this study is the period of the morphological exploration of the pancreas from the discovery of islets of LANGERHANS (1869) to the discovery of pancreas-diabetes through von MERING and MINKOWSKI (1889) investigated. In his thesis has PAUL LANGERHANS the islets of pancreas and the centro-acinar cells described. In the period from 1869 to 1889 has the majority of investigators the opinion that the islets are parts of the lymphatic system. In the other hand investigators have the opinion that islets are parts of pancreatic ducts or residues of the embryonic period. RENAUT (1879) makes it possible that islets are derivatives of epithelial tissues. KUHNE (1875) gives the description of vessels in the islets of Langerhans. KUHNE and LEA (1882) have found that islets are independent of acini. This hypothesis has RUDOLPH HEIDENHAIN (1875) supposed.

Anatomy↗
PubMed1990

A critical appraisal of studies of the pancreas. Animal models used in pancreas research: studies on feedback regulations of the pancreas.

This article suggests that for the concept of feedback regulation of the pancreas the application of animal data to humans has obvious limitations. The introduction of the synthetic protease inhibitor camostate (FOY 305) offered the possibility of designing studies in animals and man using the same compound as tool thus allowing reliable comparisons between the different experiments. These experiments revealed that cholecystokinin (CCK) has a dominant role in rats but it has no proven significance for feedback regulation in humans. The existence of such species differences should be kept in mind in studies dealing with pancreatic secretion, growth, pancreatitis, cancer, or related questions.

Animals↗
PubMed1978

[The anatomical and histological investigation of the pancreas in the 19th century and till the discovery of insulin (1921). 4. The pancreas-research after the discovery of pancreas-diabetes (1889) till the discovery of insulin].

In this study is the history of the pancreas-research between 1889 and 1921 described. In this period are any important discoverys detected: The islets have 2 cell types (TSCHASSOW-NIKOW 1900, 1906); the connection between diabetes mellitus and islet-alterations (OPIE 1900); the independence of islets on exocrine parenchyma (SCHULZE 1900); the discovery of internal secretion (BAYLISS, STARLING 1902) and the regeneration of islets in mammals and the man (KYRLE 1908; WEICHSELBAUM 1908 in independent publications.

Diabetes Mellitus↗
PubMed1999

Analyses of pancreas transplant outcomes for United States cases reported to the United Network for Organ Sharing (UNOS) and non-US cases reported to the International Pancreas Transplant Registry (IPTR).

As of September 1999, almost 13,000 pancreas transplants had been reported to the IPTR, > 9,000 in the US and > 3,000 outside the US. An era analysis of US cases from 1987 to 1997 showed a progressive improvement in outcome (p < 0.04), with pancreas transplant graft survival rates (GSRs) going from 74% to 85% at one year for SPK cases, from 56% to 75% for PAK cases, and from 50% to 69% for PTA cases. The improvements were due both to decreases in technical failure (TF) rates (overall from 16% to 8%) and immunological failure rates (going from 6% to 2% for SPK, from 23% to 7% for PAK, and from 35% to 9% for PTA cases). The proportion of recipients > 44 years old increased from 5% to 24%, and the improved outcomes encompassed the older patients as well. In patients > 44 years old, SPK pancreas GSRs at one year increased from 69% for 1987-89 cases to 79% for 1996-97 cases (p < 0.03). Pancreas GSRs were also similar for recipients reported to have Type I or Type II diabetes (at 1 year, 84% and 81%, respectively, for 1994-99 SPK transplants), the latter designated in 3% of the recipients. Contemporary pancreas transplant outcomes were calculated separately for 1996-99 US and non-US cases. US patient survival rates at one year were > or = 95% in each recipient category, with one year pancreas GSRs of 84% for SPK (n = 2,502), 76% for PAK (n = 404), and 72% for PTA (n = 176) (p = 0.0001). The immunological graft failure rates for 1996-99 US SPK, PAK and PTA cases were 2%, 6%, and 10% at one year (p = 0.001). There was a progressive increase in the use of ED (as opposed to BD) for duct management, up to nearly 60% of US pancreas transplants by 1998. Approximately 18% of SPK ED transplants had venous drainage via the portal system. Pancreas GSRs were not significantly different for 1996-99 ED (n = 1,170) and BD (n = 1,203) US SPK transplants (84% and 85%, respectively, at 1 year), nor was there any difference in pancreas GSRs for systemic (n = 437) versus portal (n = 194) venous drained ED SPK transplants (84% and 83%, respectively, at 1 year). Interestingly, kidney GSRs were significantly higher for ED versus BD US SPK cases, 93% versus 84% at one year (p = 0.003). Duct management did matter for solitary (PAK and PTA) pancreas transplants. PAK pancreas GSRs were 80% at one year for BD (n = 238) versus 68% for ED (n = 156) US transplants. PTA pancreas GSRs were 78% at one year for BD (n = 98) versus 63% for ED (n = 73) US transplants. However, BD transplants were associated with a 12% conversion rate to ED by 2 years after transplantation. Analyses of outcome by immunosuppression for US cases showed pancreas GSRs to be higher in SPK recipients given MMF (87% at 1 year) than in those who were not (76% at 1 year). For PAK and PTA recipients, those given anti-T cell for induction and TAC and MMF for maintenance immunosuppression had the highest GSRs: 86% and 83%, respectively, at one year for BD pancreas transplants; not significantly different from the pancreas GSR (87% at 1 year) in BD SPK recipients also given anti-T cell for induction and TAC and MMF for maintenance immunosuppression. Analyses of US pancreas transplant outcome according to HLA matching showed no effect at all in the SPK category, while for PAK and PTA transplants an effect was seen at the A and B loci, strongest at the B loci. Matching for at least one antigen at both loci was associated with one-year pancreas GSRs of 85% for PAK and 74% for PTA, versus 70% and 60%, respectively, at one year for those who were not matched for at least one antigen at both the A and B loci. In regard to non-US cases, the overwhelming majority were in the SPK category (n = 528 for 1996-99), with one-year pancreas GSR of 79%, not significantly different from US cases. Approximately 40% of non-US SPK cases were ED (n = 204), and, as in the US, the pancreas GSRs were similar for ED and BD transplants in this category. (ABSTRACT TRUNCATED)

Adult↗
PubMed2002

Pancreas transplant outcomes for United States (US) and non-US cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR) as of October 2002.

As of October 10, 2002, nearly 19,000 pancreas transplants had been reported to the IPTR, approximately 14,000 in the US and approximately 5,000 outside the US. An era analysis of US cases from 1987-2002 showed a progressive improvement in outcome (p < 0.04), with pancreas transplant graft survival rates (GSRs) going from 75% at one year for 1988-89 to 85% for 2000-2001 SPK cases, from 53% to 77% for PAK cases, and from 48% to 73% for PTA cases. The improvements were due both to decreases in technical failure (TF) rates (from 16% to 8% in SPK, 16% to 9% in PAK, and 19% to 13% in PTA) and immunological failure rates (going from 5% to 2% for SPK, from 27% to 6% for PAK, and from 37% to 9% for PTA cases). The proportion of recipients > 45 years old increased from 9-11% for 1987-92 to 25-30% for 1999-2002 cases, and the improved outcomes encompassed the older patients as well. Contemporary pancreas transplant outcomes were calculated separately for 1996-2002 US and non-US cases. The results of the US analysis are summarized first. US patient survival rates at one year were > or = 94% in each recipient category, with one-year primary pancreas GSRs of 84% for SPK (n = 5.784), 76% for PAK (n = 1,033), and 77% for PTA (n = 470) (p < 0.0001). The immunological graft failure rates for 1996-2002 technically successful SPK, PAK and PTA cases were 2% (n = 5,231), 7% (n = 907), and 8% (n = 404) at one year (p = 0.0001). There was a progressive increase in the use of ED as opposed to BD) for duct management. For 1996-2002 US primary pancreas transplants, ED was used in 65% of SPK, 50% of PAK and 46% for PTA cases. Of the ED transplants, venous drainage via the portal system was used for 23% or SPK, 27% of PAK and 43% of PTA cases. Pancreas GSRs were not significantly different for 1996-2002 ED (n = 3,708) and BD (n = 1,942) SPK transplants (84% and 85%, respectively, at one year), nor was there a difference in pancreas GSRs for systemic (n = 2,859) versus portal (n = 842) venous drained ED SPK transplants (84% vs. 85% at one year). Kidney GSRs were slightly higher for ED versus BD SPK cases, 92% versus 90% at one year (p < 0.003). Pancreas GSRs for PAK transplants were 80% at one year for BD (n = 495; all systemic venous drainage) versus 72% for ED with systemic (n = 357) versus 71% for ED with portal (n = 134) venous drainage (p = 0.004 overall, but p = ns for ED portal vs. systemic). For PTA cases, one-year GSRs were 78% with BD (n = 240; all systemic venous drainage) versus 70% for ED with systemic (n = 115) versus 81% for ED with portal (n = 88) venous drainage (p = 0.2 overall, and 0.09 for ED portal vs. ED systemic). BD transplants were associated with a 12% conversion rate to ED by 2 years posttransplant in all 3 recipient categories. The age of US pancreas transplant recipients made little difference for outcome in the SPK category, with one-year pancreas GSRs ranging from 82% to 85% for patients grouped by age in decades from 10-19 to 60-69 years. In the PAK category, one-year GSRs progressively increased with each decade of age, going from 69% for those 20-29 to 83% for those 60-69 years old. Likewise, in the PTA category one-year GSRs increased with each decade of age, going from 41% for the 10-19 to 65% for the 20-29 to 76% for the 30-39 to 83% for the 40-49 to 85% for the 60-69 year old recipients. Pancreas GSRs were identical (84% at one year) for 1996-2002 US SPK recipients reported to have Type 1 (n = 5,356) or Type 2 (n = 288) diabetes (5% classified as Type 2). TAC+MMF was the dominant maintenance immunosuppressant for 1996-2002 US cases (approximately 60%), and with this regimen one-year GSRs were > or = 80% in all 3 recipient categories. An analysis of GSRs according to type of anti-T-cell antibody agents (depleting vs. non-depleting vs. none) for induction therapy in TAC+MMF treated recipients did not detect significant differences in any of the categories. The absolute numbers and the proportions of US pancreas grafts that were retransplants in the SPK and PTA categories (1% and 10% respectively) were relatively small, while a large number of the PAK grafts were retransplants (n = 346; 32% of the total). The majority of the latter were done after isolated failure of a pancreas graft in SPK recipients. In the SPK (n = 78) and PTA (n = 53) categories, the retransplant GSRs were significantly (p --> 0.06) lower than those for primary transplants. In the PAK category, however, GSRs were not significantly different (p = 0.14) for retransplant versus primary cases (72% and 76%, respectively, at one year). Known causes of death in 1996-2002 US pancreas recipients were tabulated for each category. Most were from cardio-cerebro-vascular accidents (1.3-2.6% incidence) or from infections (1.2-1.4% incidence), while death from malignancy or PTLD was reported in < or = 0.6% of recipients. In regard to non-US pancreas transplants, the overwhelming majority were in the SPK category (n = 2,163 for 1996-2002), with one-year patient, kidney and pancreas survival rates of 96%, 91% and 85% as good or better than the outcomes for US cases. In summary, with modern immunosuppression (TAC + MMF for maintenance) 1996-2002 pancreas transplant graft survival rates were > or = 80% at one year in all categories of recipients (SPK, PAK, PTA). The solitary pancreas transplant outcomes continue to improve as more are done.

Demography↗
PubMed2003

[Anatomy of the head of the pancreas and various limited resection procedures for intraductal papillary-mucinous tumors of the pancreas].

The surgical anatomy, as well as the results of anatomic investigation of the pancreas, are reviewed. Anatomic descriptions, which are useful not only for ordinary pancreaticoduodenectomy or distal pancreatectomy, but also for limited resection of the pancreas for low-grade malignancy such as mucin-producing tumors or cystic lesions of the pancreas, are also provided. The fusion fascia of the head of the pancreas is called the "fusion fascia of Treitz" and that of the body and tail of the pancreas is termed the "fusion fascia of Toldt." The fusion fascia is histologically composed of a loose connective tissue membrane. All of the important pancreaticoduodenal arcades of arteries and veins are situated on this membrane, i.e. between this membrane and the pancreatic parenchyma. The topography of the head of the pancreas shows that, after branching from the gastroduodenal artery, the anterior superior pancreaticoduodenal artery runs toward a point 1.5 cm below the papilla of Vater, then turns to the posterior aspect of the pancreas to join the anterior inferior pancreaticoduodenal artery. For preserving the duodenum, the artery toward the papilla is very important. The artery toward the papilla of Vater runs along the right side of the common bile duct after branching from the posterior superior pancreaticoduodenal artery. The gastrocolic trunk of Henle has been reported to be found in about 60% of individuals. It is possible that the gastroepiploic vein and anterior superior pancreaticoduodenal vein (ASPDV) can be divided at pancreaticoduodenectomy with preservation of the superior right colic vein if this area is free of carcinoma. The ASPDV and anterior inferior pancreaticoduodenal vein (AIPDV) form an arcade on the anterior surface of the pancreas. However, arcade formation was not found between the posterior superior pancreaticoduodenal vein (PSPDV) and posterior inferior pancreaticoduodenal vein (PIPDV) in many of the cases examined. The vein joined by the inferior mesenteric vein was also investigated. We termed the artery originating from the gastroduodenal (GD) or dorsal pancreatic (DP) arteries, located on the cranial side of the head of the pancreas, the supra-transverse pancreatic (supra-TP) artery. Surgeons should be aware of the presence of the supra-TP artery during pancreatic surgery. The type of procedure used for intraductal papillary-mucinous tumor (IPMT) of the pancreas is various. The standard operations, such as pancreaticoduodenectomy, pylorus-preserving pancreaticoduodenectomy, and distal pancreatectomy with splenectomy, are performed. In some cases, limited resection such as uncal resection, pancreatic head resection with segmental duodenectomy, duodenum-preserving subtotal resection of the head of the pancreas, and spleenpreserving distal pancreatectomy with conservation of the splenic artery and vein are also performed. However, the type of procedure to use for IPMT is unclear, since there are still many unanswered questions regarding IPMT. Those unanswered questions include how a differential diagnosis of benign or malignant can be made clinically, how the extent of tumorous spread can be determined clinically, and whether patients with this disease can be cured after the tumor apparently infiltrates. IPMT may show multicentric development, while ordinary duct cell carcinoma may easily develop in the pancreas with IPMT. The reasons why duodenum-preserving resection of the pancreatic head is not popular involve the above problems and other technical problems. With preservation of the residual pancreas to maintain the duodenum and/or bile duct, the cut end of the pancreas may more frequently be positive for tumor cells, and IPMT and/or duct cell carcinoma may develop more often in the residual pancreas. We face the problem of whether several types of limited resection of the pancreas are suitable for IPMT with surgical indications due to possible malignancy and/or considerable ductal spread of neoplastic epithelia. When the pancreas head is completely resected, the bile duct, the papilla of Vater, and/or part of the duodenum should also be resected, and the significance of function-preservation declines. Important points for the future development of duodenum-preserving resection of the pancreatic head include clarifying the unanswered questions about IPMT, solving technical problems through the accumulation of anatomic and basic studies, and reporting objective results obtained in successful duodenum-preserving procedures. On the other hand, distal pancreatectomy that preserves both the splenic artery and vein and the spleen is steadily gaining popularity. Although this procedure is somewhat complicated, it is not technically difficult and can be safely performed by any surgeon. This procedure is indicated for some cases with chronic pancreatitis and IPMT.

Adenocarcinoma, Mucinous↗
PubMed2000

Pancreas transplant outcomes for United States (US) cases reported to the United Network for Organ Sharing (UNOS) and non-US cases reported to the International Pancreas Transplant Registry (IPTR) as of October, 2000.

As of October 2000, > 15,000 pancreas transplant had been reported to the IPTR, > 11,000 in the US and > 4,000 outside the US. An era analysis of US cases from 1987-2000 showed a progressive improvement in outcome (p < 0.04), with pancreas transplant graft survival rates (GSRs) going from 72% to 82% at one year for SPK cases, from 52% to 74% for PAK cases, and from 47% to 76% for PTA cases. The improvements were due both to decreases in technical failure (TF) rates (overall from 16% to 7%) and immunological failure rates (going from 8% to 2% for SPK, from 27% to 6% for PAK, and from 37% to 12% for PTA cases). The proportion of recipients > 45 years old increased from 5% to 25%, and the improved outcomes encompassed the older patients as well. In patients > 45 years old, SPK pancreas GSRs at one year increased from 62% to 78% (p < 0.002). Pancreas GSRs were also similar for recipients reported to have Type 1 or Type 2 diabetes (at one year, 84% and 83%, respectively for 1996-2000 SPK transplants), the latter designated in 3% of the recipients. Contemporary pancreas transplant outcomes were calculated separately for 1996-2000 US and non-US cases. US patient survival rates at one year were > or = 94% in each recipient category, with one-year pancreas GSRs of 84% for SPK (n = 3,697), 76% for PAK (n = 696), and 71% for PTA (n = 300) (p = 0.0001). The immunological graft failure rates for 1996-2000 US SPK, PAK and PTA cases were 2%, 6%, and 8% at one year (p = 0.001). There was a progressive increase in the use of ED (as opposed to BD) for duct management, to > 50% for 1996-2000 US SPK transplants. Approximately 20% of US SPK ED transplants had venous drainage via the portal system. Pancreas GSRs were not significantly different for 1996-2000 ED (n = 1,940) and BD (n = 1,541) US SPK transplants (83% and 84%, respectively, at one year), nor was there a difference in pancreas GSRs for systemic (n = 1,509) versus portal (n = 411) venous drained ED SPK transplants (83% for both at one year). Kidney GSRs were also not significantly different for ED versus BD US SPK cases, 93% versus 91% at one year (p = 0.13). Duct management did matter for solitary (PAK and PTA) pancreas transplants (P < or = 0.07). Pancreas GSRs for PAK recipients were 77% at one year for BD (n = 359) versus 67% for ED (n = 306) US transplants; for PTA 75% (n = 174) versus 63%. However, BD transplants were associated with a 12% conversion rate to ED by 2 years after transplantation. Analyses of outcome by immunosuppression for US cases showed pancreas GSRs ranged from 77% to 88% at one year, but were highest in SPK recipients given anti-T-cell agents for induction and CSA-MMF for maintenance immunosuppression. For PAK and PTA recipients, those given anti-T-cell agents for induction and TAC-MMF for maintenance immunosuppression had the highest GSRs: 78% and 78%, respectively, at one year for BD pancreas transplants (vs. 85% in BD SPK recipients similarly immunosuppressed, P > 0.08). In regard to non-US cases, the overwhelming majority were in the SPK category (n = 676 for 1996-2000), with a one-year pancreas GSR of 84%, not significantly different than for US cases. In summary, pancreas transplant graft survival rates were > 70% in the solitary (PAK and PTA) and > 80% in SPK recipients during the last 4 years of the 20th century. These outcomes culminate a third of a century of application for the treatment of diabetes mellitus.

Adult↗
PubMed2001

Analysis of United States (US) and non-US pancreas transplants reported to the United network for organ sharing (UNOS) and the international pancreas transplant registry (IPTR) as of October 2001.

As of October 10, 2001, > 17,000 pancreas transplant had been reported to the IPTR, > 11,500 in the US and > 4,700 outside the US. An era analysis of US cases from 1987 to 2001 showed a progressive improvement in outcome (p < 0.04), with pancreas transplant graft survival rates (GSRs) going from 75% to 83% at one year for SPK cases, from 50% to 78% for PAK cases, and from 49% to 78% for PTA cases. The improvements were due both to decreases in technical failure (TF) rates (from 14% to 7% in SPK, 23% to 8% in PAK, and 23% to 10% in PTA) and immunological failure rates (going from 7% to 2% for SPK, from 25% to 2% for PAK, and from 28% to 4% for PTA cases). The proportion of recipients > 45 years old increased from 5% to 25%, and the improved outcomes encompassed the older patients as well. In patients > 45 years old, SPK pancreas GSRs at one year increased from 74% to 80% (p < 0.007). Pancreas GSRs were also similar for recipients reported to have Type 1 or Type 2 diabetes (at one year, 84% and 83%, respectively for 1997-2001 SPK transplants), the latter designated in 5% of the recipients. Contemporary pancreas transplant outcomes were calculated separately for 1997-2001 US and non-US cases. US patient survival rates at one year were > or = 95% in each recipient category, with one year pancreas GSRs of 83% for SPK (n = 3885), 79% for PAK (n = 630), and 78% for PTA (n = 240) (p = 0.0002). The immunological graft failure rates for 1997-2001 US SPK, PAK and PTA cases were 4%, 6%, and 8% at one year (p = 0.0001). There was a progressive increase in the use of ED (as opposed to BD) for duct management, to 67% for 1997-2001 US SPK transplants, 51% for PAK and 42% for PTA. Of US SPK ED transplants, 22% had venous drainage via the portal system. US pancreas GSRs were not significantly different for 1997-2001 ED (n = 2,519) and BD (n = 1,260) US SPK transplants (82% and 85%, respectively, at one year), nor was there a difference in pancreas GSRs for systemic (n = 1,958) versus portal (n = 557) venous-drained ED SPK transplants (82% vs. 84% at one year). Kidney GSRs were slightly higher for ED versus BD US SPK cases, 93% versus 91% at one year (p = 0.03). Duct management did matter for solitary (PAK and PTA) pancreas transplants. Pancreas GSRs for PAK recipients were 85% at one year for BD (n = 316) versus 74% for ED (n = 303) US transplants (p < 0.02); for PTA 81% (n = 168) versus 74% (p > or = 0.37). However, BD transplants were associated with a 12% conversion rate to ED by two years posttransplant. Recipient age made little difference for outcome in any category. Indeed, in the PTA category GSRs were significantly higher for US recipients > 45 years old (n = 66) than 21-45 years old (n = 216), 85% versus 77% at 1 year (p < or = 0.10). TAC + MMF was the dominant maintenance immunosuppressant for 1999-2001 US cases (> 70%). In an analysis of outcome according to type of anti-T-cell antibody agents (depleting vs. non-depleting vs. none) for induction therapy in TAC + MMF treated recipients, there were no differences in GSRs in any of the categories. In regard to non-US cases, the overwhelming majority were in the SPK category (n = 1,649 for 1997-2001), with a one year pancreas GSR of 82%, not significantly different than for US cases. In summary, pancreas transplant graft survival rates were nearly 80% at one year in recipients of solitary (PAK and PTA) pancreas transplants, and > 80% in SPK recipients for 1997-2001 cases. The outcome continues to improve as increasing numbers of solitary pancreas transplants are done.

Adult↗
PubMed1992

Non-icteric pancreas head carcinoma fares worse than icteric pancreas head carcinoma.

A total of 22 patients with non-icteric pancreas head carcinoma were retrospectively compared with 61 patients with icteric pancreas head carcinoma. No significant difference was found regarding age, sex, greatest diameter, macroscopic type, microscopic type, stage, lymphatic permeation, perineural infiltration, venous invasion, lymph node metastasis, and the presence of cancer cells at the surgical margins. The main location of pancreas head carcinoma could be divided into two sites: the superior (pericholedochal), and inferior or distal (excholedochal) areas of the pancreas head. Sixteen (73%) of the 22 non-icteric pancreas head carcinomas were located in the inferior or distal area (excholedochal), while 28 (46%) of the 61 icteric pancreas head carcinomas were situated in the superior portion (pericholedochal) (P less than 0.05). One (5%) of the 22 non-icteric pancreas head carcinomas was small pancreas carcinoma, compared with 11 (18%) of the 61 icteric pancreas head carcinomas. The cumulative 2-year and 4-year survival rates of the 22 patients with non-icteric pancreas head carcinoma were significantly worse than those of the 61 patients with icteric pancreas head carcinoma [7.9% vs. 24.6% (P less than 0.05) and 0% vs. 13.4% (P less than 0.01)]. These findings suggest that non-icteric pancreas head carcinomas normally arise in an area far from the biliary tree, and include a greater number of large tumors. Any resulting difficulty and delay in the diagnosis and treatment of this disease will usually lead to a worsening of the clinical course of non-icteric pancreas head carcinoma.

Age Factors↗
PubMed1998

Analysis of United States (US) and non-US pancreas transplants as reported to the International Pancreas Transplant Registry (IPTR) and to the United Network for Organ Sharing (UNOS).

As of November 1998, more than 11,000 pancreas transplants had been reported to the IPTR, including more than 8,800 US and more than 2,600 non-US cases. The 1994-98 cases (> 4,500) were analyzed, including more than 4,000 US and more than 500 non-US transplants. For all US 1994-98 SPK transplants (n = 3,409), one-year patient, pancreas and kidney graft survival rates were 94%, 90% and 83%, respectively; for all PAK cases (n = 375), one-year patient and graft survival rates were 95% and 71%; and for all PTA cases (n = 181), one-year patient and graft survival rates were 95% and 64%, respectively. Recipient age had only a small impact on outcome, with one-year patient survival rates for all recipients < 45 years of 95% (n = 3,215) versus 91% for those > or = 45 years old (n = 758) (p = 0.005). Pancreas graft survival rates at one year for those < 45 versus > or = 45 years old were 84% versus 78% in the SPK (p < 0.02), 70% versus 78% in the PAK (p = 0.13), and 62% versus 79% in the PTA (p = 0.23) categories, respectively). Nearly one-third of US pancreas transplants for 1994-98 were done by the ED drainage technique. For SPK transplants, the one-year pancreas graft survival rate was 83% for BD (n = 2,369) and 82% for ED (n = 912) (p < or = 0.09). For PAK and PTA transplants, pancreas graft survival rates were significantly higher with BD, 74% (n = 261) and 68% (n = 115), respectively, at one year. The drawback for BD was the need for conversion to ED in 7% of the cases at one year and 11% at 2 years. For TS transplants, the pancreas graft loss due to rejection was very low for SPK transplants, 2% at one year versus 9% for PAK and 15% for PTA cases. The various initial maintenance immunosuppressive regimens (Tac + MMF, Tac + Aza, CsA + MMF, CsA + Aza) resulted in only minor differences in pancreas graft survival rates in the SPK cases (80-86% at 1 year), but in PAK and PTA cases the Tac + MMF combination was associated with significantly higher pancreas graft survival rates. For BD PAK transplant recipients given Tac + MMF, the one-year pancreas graft survival rate was 83% (n = 100). For the corresponding BD PTA group it was 75% (n = 44). For non-US cases the outcomes were similar. For non-US SPK transplants (n = 586), one-year patient, kidney and pancreas graft survival rates were 93%, 85% and 81%, respectively. Cox multivariate analyses and logistical regression were done in each recipient category to assess the factors that influence pancreas graft loss. BD was associated with a significantly lower risk than ED in all categories. Increasing donor age was a risk factor in most categories. MMF was associated with a decreased risk for graft loss in the SPK category, and Tac in the PAK and PTA categories.

Adult↗
PubMed1996

Isolated pancreas rejection in combined kidney pancreas tranplantation.

The clinical success of pancreas transplantation is limited by the difficulty in diagnosing rejection. In simultaneous pancreas kidney (SPK) transplantation, the diagnosis of pancreatic rejection is particularly difficult in the absence of clinical evidence of kidney rejection. Moreover, patients receiving only pancreas grafts will not have a concomitantly grafted kidney to serve as a "sentinel" for rejection. Percutaneous pancreas graft biopsy has been reported in a few small series but has not been adopted for broad clinical use. We describe the evaluation of 69 consecutive episodes of suspected isolated pancreas allograft rejection by percutaneous pancreas allograft biopsy. These rejection episodes occurred in 41 patients with bladder-drained pancreas transplants (25 SPK, 14 pancrease after kidney transplants [PAK], amd two pancreas transplant alone [PTA]). The indications for percutaneous pancreas biopsy were a twofold or greater increase in serum amylase or lipase, or a sustained 40% to 50% drop in urine amylase in the setting of no evidence of renal allograft dysfunction in SPK transplants. Biopsies were performed with color-flow Doppler ultrasound localization using an 18-gauge automated biopsy needle. Pancreatic tissue adequate for histologic evaluation was obtained in 61 of 69 cases (88%). There were two cases of intraabdominal bleeding, one of which required surgical intervention; the other resolved spontaneously. Histologic assessment of the biopsies demonstrated varying degrees of acute cellular rejection in 48 of 61 specimens (79%). Twelve specimens (20%) were free of histologic evidence of rejection, and one specimen (2%) showed acute pancreatitis. At the time of suspected rejection mean serum amylase and lipase values were increased 3.6 and 8.3-fold, respectively, and urine amylase was decreased by a mean of 45%. We conclude that the commonly used markers for pancreas allograft rejection are only about 80% specific for acute rejection. Percutaneous pancreas allograft biopsy is safe and allows the avoidance of unnecessary antirejection therapy with its attendant side effects and cost.

Adult↗
PubMed1996

Delayed endocrine pancreas graft function after simultaneous pancreas-kidney transplantation. Incidence, risk factors, and impact on long-term outcome.

BACKGROUND: The incidence of delayed endocrine pancreas graft function and its impact on long-term outcome after simultaneous pancreas-kidney transplantation are unknown. METHODS: We studied 54 technically successful adult type I insulin-dependent diabetic recipients of cadaver, whole organ, bladder-drained simultaneous pancreas-kidney transplants (mean age, 37.6 years; 65% male, 35% female; 9% pancreas retransplants; 63% on chronic pretransplant dialysis; mean duration of diabetes, 25.1 years). Insulin was administered during the first 2 weeks after transplantation, as needed, to keep blood glucose < 150 mg/dl. Delayed endocrine pancreas graft function was defined as total, cumulative insulin requirement of > 30 U between day 5 and day 10, and/or > 15 U between day 11 and 15. Quadruple immunosuppression was used for all recipients. RESULTS: The incidence of delayed endocrine pancreas graft function was 69%. By univariate analysis, delayed endocrine graft function was associated with pretransplant recipient weight > 80 kg (P = 0.04), donor age > 45 years (P = 0.02), and cardiocerebrovascular (P = 0.06) and nontraumatic causes of donor death (P = 0.02). The incidence of acute pancreas rejection episodes was similar for recipients without and with delayed endocrine pancreas graft function. Pancreas graft survival at 1 and 3 years was 94% and 82% without versus 76% and 59% with delayed endocrine graft function (P = 0.03). CONCLUSIONS: Increased pancreas graft failure after delayed endocrine function was a consequence of insufficient functional reserve (e.g., older donors) rather than increased immunogenicity. Pretransplant reduction of recipient weight and careful donor selection are therefore crucial in order to decrease the incidence of delayed endocrine pancreas graft function and its negative impact on long-term outcome.

Adult↗
PubMed1999

[Organ donation by living donors in isolated pancreas and simultaneous pancreas-kidney transplantation].

We studied retrospectively 106 pancreas transplants from living donors. Of these, 83 were solitary pancreas transplants, done between June 1979 and December 1997 (51 pancreas transplants alone for non-uremic recipients as well as 32 pancreas-after-kidney transplants for previously uremic recipients with a functioning kidney graft), and 23 were simultaneous pancreas-kidney transplants (SPK), done between March 1994 and December 1997. In all, 105 (99%) donors were genetically related to the recipients. Perioperative donor mortality was 0%. Donor complications included 9 splenectomies as well as 4 operatively drained and 7 percutaneously managed peripancreatic fluid collections. We noted hyperglycemia in 3 (3%) donors (all among the initial cases in this series). The 1-year survival rate was 50% for solitary pancreas recipients and 78% (pancreas) and 100% (kidney) for SPK recipients. Of the 5 pancreas graft losses which occurred after SPK, 3 were due to thrombosis, 1 to pancreatitis and infection, and 1 to chronic rejection. Currently, all kidney grafts and 18 pancreas grafts are functioning in these 23 dual organ recipients (with 0% recipient mortality). Living donor pancreas and SPK grafting is associated with low donor morbidity and good graft outcome. With stringent donor criteria and appropriate counseling of the prospective donor/recipient pairs, living donor pancreas transplants may become a more widely applied therapeutic alternative for selected non-uremic and uremic patients with Type I diabetes.

Diabetes Mellitus, Type 2↗