Browsing by Subject "pancreas transplantation"

Now showing 1 - 6 of 6
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    Broadened Allocation of Pancreas Transplants Across Compatible ABO Blood Types
    (Elsevier, 2017-12) Fridell, Jonathan A.; Gustafson, Sally K.; Thompson, Bryn W.; Fox, Abigail C.; Prentice, Matthew A.; Curry, Michael A.; Odorico, Jon S.; Surgery, School of Medicine
    Background Current Organ Procurement and Transplantation Network (OPTN) policy restricts certain blood type-compatible simultaneous pancreas and kidney (SPK) transplants. Using the Kidney Pancreas Simulated Allocation Model, we examined the effects of 5 alternative allocation sequences that allowed all clinically compatible ABO transplants. Methods The study cohort included kidney (KI), SPK, and pancreas alone (PA) candidates waiting for transplant for at least 1 day between January 1, 2010, and December 31, 2010 (full cohort), and kidneys and pancreata recovered for transplant during the same period. Additionally, because the waiting list has shrunk since 2010, the study population was reduced by random sampling to match the volume of the 2015 waiting list (reduced cohort). Results Compared with the current allocation sequence, R4 and R5 both showed an increase in SPK transplants, a nearly corresponding decrease in KI transplants, and virtually no change in PA transplants. Life-years from transplant and median years of benefit also increased. The distribution of transplants by blood type changed, with more ABO:A, B, and AB transplants performed, and fewer ABO:O across all transplant types (KI, SPK, PA), with the relative percent changes largest for SPK. Discussion Broadened ABO compatibility allowances primarily benefitted SPK ABO:A and AB candidates. ABO:O candidates saw potentially reduced access to transplant. The simulation results suggest that modifying the current allocation sequence to incorporate broadened ABO compatibility can result in an increase in annual SPK transplants.
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    Donation After Circulatory Arrest in Pancreas Transplantation: A Report of 10 Cases
    (Elsevier, 2017-12) Fridell, Jonathan A.; Mangus, Richard S.; Thomas, Christopher M.; Kubal, Chandrashekhar A.; Powelson, John A.; Surgery, School of Medicine
    Introduction Transplantation of pancreas allografts procured from donation after circulatory death (DCD) remains uncommon. This study reviews a series of pancreas transplants at a single center to assess the donor and recipient characteristics for DCD pancreas transplant and to compare clinical outcomes. Methods DCD procurement was performed with a 5-minute wait time from pronouncement of death to first incision. In 2 patients, tissue plasminogen activator was infused as a thrombolytic during the donor flush. All kidney grafts were placed on pulsatile perfusion. Results There were 606 deceased donor pancreas transplants, 596 standard donors and 10 DCD donors. Of the 10 DCD transplants, 6 were simultaneous pancreas-kidney and 4 were pancreas transplant alone. The average time from incision to aortic cannulation was less than 3 minutes. The median total ischemia time for the DCD grafts was 5.4 hours, compared with 8.0 hours for standard donors (P = .15). Median length of hospital stay was 7 days for both groups, and there were no episode of acute cellular rejection in the first year post-transplant for the DCD group (4.2 % for standard group, P = .65). There was no difference in early or late graft survival, with 100% graft survival in the DCD group up to 1 year post-transplant. Ten-year Kaplan-Meier analysis shows similar graft survival for the 2 groups (P = .92). Conclusions These results support the routine use of carefully selected DCD pancreas donors. There were no differences in graft function, postoperative complications, and early and late graft survival.
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    Pancreas Transplantation Alone: Radical or Rationale?
    (Wolters Kluwer, 2021-01) Stratta, Robert J.; Fridell, Jonathan A.; Surgery, School of Medicine
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    Pancreas transplantation following total pancreatectomy for chronic pancreatitis
    (Wiley, 2019-12) Cerise, Adam; Nagaraju, Santosh; Powelson, John A.; Lutz, Andrew; Fridell, Jonathan A.; Surgery, School of Medicine
    Background Total pancreatectomy for chronic pancreatitis leads to brittle diabetes and challenging glycemic control with half of all patients experiencing severe hypoglycemia, many requiring medical intervention or hospitalization. Pancreas transplantation has the potential to manage both the endocrine and the exocrine insufficiency in this patient population. Methods Between June 1, 2005, and July 1, 2016, 8 patients with brittle diabetes following total pancreatectomy underwent pancreas transplantation. All grafts had systemic venous and enteric exocrine drainage. Data included demographics, graft and patient survival, pre‐ and post‐transplant supplementation with pancreatic enzymes, and narcotic usage. Results Patient survival rate at 1 and 3 years was 88%. Pancreas graft survival rate of those alive at 1 year was 100% and 86%, respectively. About 75% of these patients remained insulin‐free until their time of death, loss of follow‐up, or present day. Of the patients with maintained graft function at 3 years, none required further hospitalization for glycemic control. About 75% of these patients have also maintained exocrine function without pancreatic enzyme supplementation. Conclusions Pancreas transplant can treat both exocrine and endocrine insufficiency and give long‐term insulin‐free survival and should be considered as a viable treatment option for patients who have undergone total pancreatectomy for chronic pancreatitis.
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    Pancreas transplantation using compatible but non‐identical ABO blood group donors
    (Wiley, 2018) Nagaraju, Santosh; Mangus, Richard S.; Powelson, John A.; Fridell, Jonathan A.; Surgery, School of Medicine
    Methods A review of all pancreas transplants from a single institution from 01/2003 to 07/2016 (n=606) revealed 41 recipients of a NIC donor pancreas which were matched for age, race, gender, year and type of transplant with 41 ABO identical cases. Groups were compared for allograft survival, incidence of acute cellular rejection (ACR), length of hospital stay, 3‐month readmissions and transfusion requirements. Serum haptoglobin and Lactate dehydrogenase were used to identify hemolysis in patients requiring repeated transfusions without overt blood loss. Results The 1‐year graft survival was 100% and 88% in the study and control groups. In the study group, 6/41(14%) developed hemolysis, all of which were ABO O into A. All responded to donor blood type specific transfusions. Discussion There are limited data on outcomes of solid organ transplant using NIC donors with almost none specifically addressing pancreas transplantation. In this study, graft survival was similar but 14% developed hemolysis, which was transient and treated with transfusion of donor blood type specific blood. Conclusion NIC pancreas transplants have similar graft survival compared to ABO identical. Hemolysis may occur so some caution is required.
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    The survival advantage of pancreas after kidney transplant
    (Wiley, 2019) Fridell, Jonathan A.; Niederhaus, Silke; Curry, Michael; Fox, Abigail; Odorico, Jon; Surgery, School of Medicine
    Patient survival after pancreas after kidney transplant (PAK) has been reported to be inferior to patient survival after simultaneous pancreas–kidney transplant (SPK). The authors examine national data to further explore allograft (kidney and pancreas) and patient survival after PAK. Kaplan–Meier and Cox proportional hazard models were used to analyze Organ Procurement and Transplantation Network data from 1995 to 2010. The analysis compared PAK and SPK candidates and recipients. Kaplan–Meier analysis results showed that PAK after either a living or a deceased donor kidney transplant is associated with increased kidney graft survival compared with recipients with type 1 diabetes who received only a kidney. The best kidney allograft survival was for patients who received a living donor kidney followed by PAK. Receiving a living donor kidney was associated with increased pancreas allograft survival compared with receiving a deceased donor kidney. PAK transplant recipients who receive both organs have a survival advantage compared with uremic candidates who receive neither (SPK waitlist). Compared with uremic diabetic waitlist patients, SPK and PAK recipients showed similar overall patient survival. Successful PAK offers a survival advantage compared with receiving neither a kidney nor a pancreas transplant. These data also suggest that receiving a pancreas (after kidney) transplant may have a protective effect on the kidney allograft.