Pancreas Transplant Imaging: How I Do It
From the Departments of Radiology (P.P.T., W.D.F., M.D.H., F.A.Q.) and Transplant Surgery (C.J.), Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226. Address correspondence to P.P.T. (e-mail: [emailprotected] ). Pancreas transplantation aims to restore physiologic normoglycemia in diabetic patients with glomerulopathy and avoid or delay the onset of diabetic retinopathy and arteriopathy. Simultaneous pancreas-kidney transplant is the most common approach, using a cadaveric pancreas donation in conjunction with either cadaveric or live donor renal transplant. Alternative techniques include pancreas after kidney transplant, in which the pancreas transplant is performed some years after renal transplant. Pancreas transplant alone is utilized rarely in diabetic patients with compensated renal function. Pancreas grafts have vascular and enteric connections that vary in their anatomic approach, and understanding of this is critical for imaging with ultrasonography, computed tomography, or magnetic resonance imaging. Imaging techniques are directed to display the pancreatic transplant arterial and venous vasculature, parenchyma, and intestinal drainage pathway. Critical vascular information includes venous thrombosis (partial or complete), arterial occlusion, or aneurysm. Parenchymal abnormalities are nonspecific and occur in pancreatitis, graft rejection, and subsequent graft ischemia. Peripancreatic fluid collections include hematoma/seroma, pseudocyst, and abscess. The latter two are related to pancreatitis, duct disruption, or leak from the duodenojejunostomy. An understanding of transplant anatomy and complications will lead to appropriate use of imaging techniques to diagnose or exclude important complications. After reading the article and taking t Continue reading >>
Umn To Celebrate 50th Anniversary Of Pancreatic Transplant
UMN to celebrate 50th anniversary of pancreatic transplant The University will be hosting a conference in May to honor the event. Since the 1960s, the University of Minnesota has performed the most pancreatic transplants in the world. On May 19, the University will host a celebration to commemorate the 50th anniversary of the first successful pancreatic transplant in 1966. Doctors from around the world will attend, along with guest speakers from different universities. The University has performedabout 1,300 transplants since 1988according to federal data. Worldwide, more than 30,000 have been performed. We remain leaders in that field, said Dr. Raja Kandaswamy a University transplant surgeon. The first pancreatic transplant patient was diabetic and became insulin-independent after the surgery. Kandaswamy said the most common pancreatic transplant surgery is the pancreatic kidney transplant, which is administered to patients who need both a kidney transplant and a new pancreas. This surgery has a success rate of 90 percent. Among the guests at the May event will be David E.R. Sutherland of the University of Minnesota, who Kandaswamy called the father of this field. Family members of Richard Lillehei, a surgeon for the first transplant, will also attend. Fredrick Merkel, who was in the operating room during the first transplant, will also be there. The typical age of people who get the transplants is between 35 and 40, with an equal percentage of men and women. The surgery has benefited thousands of diabetics, some of whom also face kidney failure. The need for pancreatic transplants has stayed level over the past decade. Dr. Kandaswamy said new technologies that allow patients to avoid a transplant exist, but none are yet clinically-approved, so a new pancreas is still Continue reading >>
Pancreas Transplantation
Author: Dixon B Kaufman, MD, PhD; Chief Editor: Ron Shapiro, MD more... The purpose of pancreas transplantation is to ameliorate type I diabetes and produce complete insulin independence. The first successful pancreas transplantation in conjunction with a simultaneous kidney transplantation was performed by W.D. Kelly, MD, and Richard Lillehei, MD, from the University of Minnesota in 1966. Until about 1990, the procedure was considered experimental. Now it is a widely accepted therapeutic modality, with virtually all insurance carriers covering the procedure, including Medicare. The pancreas comes from a deceased organ donor. However, select cases of living-donor pancreas transplantations have been performed. About 100 transplant centers in the United States perform pancreas transplantations. About 1200 cases are performed annually in the United States. About 75% of pancreas transplantations are performed with kidney transplantation (both organs from the same donor) in patients with renal failure who are diabetic. This is referred to as a simultaneous pancreas-kidney (SPK) transplantation. About 15% of pancreas transplantations are performed after a previously successful kidney transplantation. This is referred to as a pancreas-after-kidney transplantation. The remaining 10% of cases are performed as pancreas transplantation alone in nonuremic patients with very labile and problematic diabetes. An alternative new therapy that may also ameliorate diabetes is islet transplantation, which is experimental and is not yet as efficient as pancreas transplantation. See the image below. Simultaneous pancreas-kidney transplantation with enteric drainage. Illustrated by Simon Kimm, MD. Image courtesy of Landes Bioscience. Experiments in pancreas transplantation began long before Continue reading >>
Pancreas Transplantation For Type 2 Diabetes Mellitus
Pancreas transplantation for type 2 diabetes mellitus Orlando, Giuseppea,b; Stratta, Robert Jc; Light, Jimmyd Purpose of reviewThis review will provide evidence that selected patients with type 2 diabetes mellitus (T2DM) may benefit from vascularized pancreas transplantation (PTX). Recent findingsInitial experience with simultaneous pancreaskidney transplantation (SPKT) in patients with T2DM and end-stage renal disease (ESRD) suggested that augmentation of endogenous insulin production by PTX in patients with C-peptide-positive, insulin-requiring diabetes resulted in insulin independence, improved glucose counter-regulation, and enhanced quality of life. A number of single-center retrospective studies have documented equivalent outcomes in patients with either type 1 diabetes mellitus (T1DM) or T2DM undergoing predominantly SPKT, although clearly a selection bias exists for patients in the latter category. Selection criteria for SPKT in T2DM include patients less than 5560 years of age with a BMI less than 3032 kg/m2, insulin-requiring for a minimum of 5 years with a total daily insulin requirement less than 1 u/kg/day, a fasting C-peptide level less than 10 ng/ml, absence of severe vascular disease or tobacco abuse, adequate cardiac function, and presence of complicated diabetes. Data from the International Pancreas Transplant Registry show that up to 7% of SPKT recipients are classified as having T2DM and that outcomes in these patients are comparable to those undergoing SPKT and classified as having T1DM. SummaryConsequently, characterization of the type of diabetes may be irrelevant and insulin-requiring diabetic patients with ESRD should be evaluated for PTX based exclusively on their predicted ability to tolerate the surgical procedure and requisite immunosuppres Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Fat loss from pancreas 'can reverse' effects of type-2 diabetes
- Insulin, glucagon and somatostatin stores in the pancreas of subjects with type-2 diabetes and their lean and obese non-diabetic controls
Pancreas Transplant - Who Can Have One - Nhs.uk
As donor pancreases are scarce, you'll need to be assessed carefully to determine whether a pancreas transplant is suitable for you and that you could benefit from one. A pancreas transplant is usually only considered in a small number of cases of people with type 1 diabetes . There are around a million people in the UK with type 1 diabetes, but only about 200 get a pancreas transplant each year. Type 1 diabetes occurs whenthe immune system destroys the cells (islets) in the pancreas that produce a hormone called insulin. It can often be controlled with insulin injections, so the risks of a pancreas transplant outweigh the benefits in many cases. However, a transplant may be considered if: you also have severe kidney disease ,whether it's caused by diabetes or not a pancreas transplant may be carried out alongside a kidney transplant in these cases you have severe episodes ofa dangerously low blood sugar level (hypoglycaemia) that occur without warning, in spite of good insulin control If a healthy pancreas is transplanted into the body, it should start producing insulin, relieving any diabetes symptoms and replacing treatment with insulin injections. A detailed assessment at a transplant centre is needed to find out more about your health, and check whether there are any underlying problems that could affect your suitability for a pancreas transplant. This will usually involve having several tests, such as: checksof your blood pressure and heart rate have a serious mental health or behavioural condition that means you would be unlikely to be able to correctly take the medication needed after a pancreas transplant are generally in poor health and are unlikely to withstand the strain of surgery and the ongoing treatment that follows it are obese you may need to lose wei Continue reading >>
Pancreas Transplantation
*Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Department of Surgery, University of Minnesota, Minneapolis, MN, USA. Correspondence to: Duck Jong Han. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap 2-dong, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-3487, Fax: +82-2-474-9027, rk.luoes.cma@nahjd Author information Article notes Copyright and License information Disclaimer Received 2009 Dec 30; Accepted 2010 Mar 3. Copyright 2010 The Korean Society of Gastroenterology, the Korean Society of Gastrointestinal Endoscopy, the Korean Society of Neurogastroenterology and Motility, Korean College of Helicobacter and Upper Gastrointestinal Research, the Korean Association for the Study of Intestinal Diseases, Korean Association for the Study of the Liver and Korean Society of Pancreatobiliary Diseases This article has been cited by other articles in PMC. Diabetes mellitus is generally treated with oral diabetic drugs and/or insulin. However, the morbidity and mortality associated with this condition increases over time, even in patients receiving intensive insulin treatment, and this is largely attributable to diabetic complications or the insulin therapy itself. Pancreas transplantation in humans was first conducted in 1966, since when there has been much debate regarding the legitimacy of this procedure. Technical refinements and the development of better immunosuppressants and better postoperative care have brought about marked improvements in patient and graft survival and a reduction in postoperative morbidity. Consequently, pancreas transplantation has become the curative treatment modality for diabetes, particularly for type I diabetes. An overview of pancreas tra Continue reading >>
Pancreas Transplant
The healthy pancreas is taken from a donor who is brain dead, but is still on life support. The donor pancreas must be carefully matched to the person who is receiving it. The healthy pancreas is transported in a cooled solution that preserves the organ for up to about 20 hours. The person's diseased pancreas is not removed during the operation. The donor pancreas is usually placed in the right lower part of the person's abdomen. Blood vessels from the new pancreas are attached to the person's blood vessels. The donor duodenum (first part of the small intestine right after the stomach) is attached to the person's intestine or bladder. The surgery for a pancreas transplant takes about 3 hours. This operation is usually done at the same time as a kidney transplant in diabetic people with kidney disease. The combined operation takes about 6 hours. Continue reading >>
Pancreas Transplantation For Type 2 Diabetes Mellitus.
Curr Opin Organ Transplant. 2011 Feb;16(1):110-5. doi: 10.1097/MOT.0b013e3283424d1f. Pancreas transplantation for type 2 diabetes mellitus. Wake Forest Institute for Regenerative Medicine, Winston Salem, North Carolina 27106, USA. This review will provide evidence that selected patients with type 2 diabetes mellitus (T2DM) may benefit from vascularized pancreas transplantation (PTX). Initial experience with simultaneous pancreas-kidney transplantation (SPKT) in patients with T2DM and end-stage renal disease (ESRD) suggested that augmentation of endogenous insulin production by PTX in patients with C-peptide-positive, insulin-requiring diabetes resulted in insulin independence, improved glucose counter-regulation, and enhanced quality of life. A number of single-center retrospective studies have documented equivalent outcomes in patients with either type 1 diabetes mellitus (T1DM) or T2DM undergoing predominantly SPKT, although clearly a selection bias exists for patients in the latter category. Selection criteria for SPKT in T2DM include patients less than 55-60 years of age with a BMI less than 30-32 kg/m, insulin-requiring for a minimum of 5 years with a total daily insulin requirement less than 1 u/kg/day, a fasting C-peptide level less than 10 ng/ml, absence of severe vascular disease or tobacco abuse, adequate cardiac function, and presence of 'complicated' diabetes. Data from the International Pancreas Transplant Registry show that up to 7% of SPKT recipients are classified as having T2DM and that outcomes in these patients are comparable to those undergoing SPKT and classified as having T1DM. Consequently, characterization of the 'type' of diabetes may be irrelevant and insulin-requiring diabetic patients with ESRD should be evaluated for PTX based exclusively o Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Fat loss from pancreas 'can reverse' effects of type-2 diabetes
- Insulin, glucagon and somatostatin stores in the pancreas of subjects with type-2 diabetes and their lean and obese non-diabetic controls
Pancreas Transplants* (including Simultaneous Pancreas-kidney, Pancreas Alone, And Pancreas After Kidney)
Pancreas Transplants* (Including simultaneous pancreas-kidney, pancreas alone, and pancreas after kidney) Benefit determinations are based on the applicable contract language in effect at the time the services were rendered. Exclusions, limitations or exceptions may apply. Benefits may vary based on contract, and individual member benefits must be verified. Wellmark determines medical necessity only if the benefit exists and no contract exclusions are applicable. This medical policy may not apply to FEP. Benefits are determined by the Federal Employee Program. This Medical Policy document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy will be reviewed regularly and be updated as scientific and medical literature becomes available. Achievement of insulin dependence with resultant decreased morbidity and increased quality of life is the primary health outcome of pancreas transplantation. Transplantation of the pancreas is a treatment method for patients with insulin dependent diabetes mellitus. Pancreas transplantation can restore glucose control and is intended to prevent, halt or reverse the secondary complications from diabetes mellitus. Replacement of the pancreas may be performed alone, following a kidney transplant, or simultaneously with a kidney transplant. Pancreas transplant alone (PTA) may be indicated for patients with uncontrolled type 1 diabetes mellitus (i.e. abnormal hemoglobin A1c, inability to maintain blood glucose levels in a normal range) but adequate renal function. The purpose of PTA is to restore glucose control and is intended toprevent, halt or reverse the secondary complications from diabete Continue reading >>
Re: Pancreas Transplantation: The Untold Origin Of The Story The Pancreas Donor
Re: Pancreas transplantation: The untold origin of the story the pancreas donor Re: Pancreas transplantation: The untold origin of the story the pancreas donor Title: Pancreas Transplantation: The untold origin of the story the pancreas Donor Authors: IM Shapey1,2 A Summers1,2, T Augustine1,2, MK Rutter1,3, D van Dellen1,2 1) Faculty of Medicine, Biology and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester UK. 2) Department of Renal and Pancreatic Transplantation, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK 3) Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK Keywords: Pancreas, Islet, Transplantation, Donor, Insulin Acknowledgements: We would like to recognise the important and life changing gift provided by organ donors and their families which has facilitated the possibility of pancreas transplantation. Funding: Medical Research Council (UK); Royal College of Surgeons of Edinburgh We read with interest Dean et. al.s State of the Art Review of Pancreas Transplantation. It is refreshing to have pancreas and islet transplantation receiving the international attention it urgently deserves. In patients with complex diabetes mellitus, pancreas and islet transplantation can offer life-changing and life-saving therapies. Improving knowledge and understanding amongst referring physicians regarding the potential benefits of pancreas transplantation is important because current referral rates to UK pancreas transplantation centres are low and do not reflect the number that may benefit from transplantation. For many decades, pancreas transplantation has been the forgotten sibling of liver, kidney and cardio-thoracic transplantation. The amelioration of Continue reading >>
Pancreas Transplantation
This article needs additional citations for verification . Please help improve this article by adding citations to reliable sources . Unsourced material may be challenged and removed. A pancreas transplant is an organ transplant that involves implanting a healthy pancreas (one that can produce insulin) into a person who usually has diabetes . Because the pancreas is a vital organ, performing functions necessary in the digestion process, the recipient's native pancreas is left in place, and the donated pancreas is attached in a different location. In the event of rejection of the new pancreas, which would quickly cause life-threatening diabetes, there would be a significant chance the recipient would not survive very well for long without the native pancreas, however dysfunctional, still in place. The healthy pancreas comes from a donor who has just died or it may be a partial pancreas from a living donor. [1] At present, pancreas transplants are usually performed in persons with insulin-dependent diabetes, who can develop severe complications. Patients with the most common, and deadliest, form of pancreatic cancer ( pancreatic adenomas , which are usually malignant, with a poor prognosis and high risk for metastasis, as opposed to more treatable pancreatic neuroendocrine tumors or pancreatic insulinomas ) are usually not eligible for valuable pancreatic transplantations, since the condition usually has a very high mortality rate and the disease, which is usually highly malignant and detected too late to treat, could and probably would soon return. In most cases, pancreas transplantation is performed on individuals with type 1 diabetes with end-stage renal disease , brittle diabetes and hypoglycaemia unawareness. The majority of pancreas transplantation (>90%) are simul Continue reading >>
Should You Get A Pancreas Transplant For Type 1 Diabetes?
You’re considering a pancreas transplant to cure your type 1 diabetes, but have questions – This episode of The Scope is for you. Dr. Jeffery Campsen, surgical director of transplants, talks about the benefits of a pancreas transplant for type one diabetes patients, how it works compared to traditional methods of controlling the disease and why it is one of the best options for many people. Transcript Announcer: Interesting, informative and all in the name of better health. This is The Scope Health Sciences Radio. Interviewer: A lot of people with Type 1 diabetes believe that the insulin shots and a pump is enough, but there might actually be a better option, a pancreas transplant. We're with Dr. Paul Campsen, Surgical Director of Pancreas Transplant Surgery with the University of Utah. That option is pancreatic surgery. Dr. Paul Campsen: That's correct. Right now we do pancreas transplants for Type 1 diabetics. Type 1 diabetics can't survive without insulin, so they give themselves shots and they can administer this sometimes through am insulin pump which is a very good way to keep them alive. The control that they get from that is not a replacement for the human organ, the pancreas. That's where the pancreas transplant comes into play in the sense that you can help yourself stay alive just like dialysis helps with kidney transplant, or with failure. A pancreas transplant gives you back the human organ that you actually need. Interviewer: Plus, also a better quality of life. Dr. Paul Campsen: A much better quality of life. Over the long term the pancreas transplant itself is completely correcting the diabetes, so any of the sequelae of diabetes, whether it be peripheral vascular disease, damage to your eyes, damage to your nerves, damage to your coronary arteries, Continue reading >>
Transplant Surgery - Chronic Pancreatitis
Transplant Surgery Conditions & Procedures Chronic Pancreatitis Pancreatitis is inflammation of the pancreas. The pancreas is a large gland behind the stomach and close to the duodenum-the first part of the small intestine. The pancreas secretes digestive juices, or enzymes, into the duodenum through a tube called the pancreatic duct. Pancreatic enzymes join with bile-a liquid produced in the liver and stored in the gallbladder-to digest food. The pancreas also releases the hormones insulin and glucagon into the bloodstream. These hormones help the body regulate the glucose it takes from food for energy. Normally, digestive enzymes secreted by the pancreas do not become active until they reach the small intestine. But when the pancreas is inflamed, the enzymes inside it attack and damage the tissues that produce them. Pancreatitis can be acute or chronic. Either form is serious and can lead to complications. In severe cases, bleeding, infection, and permanent tissue damage may occur.Both forms of pancreatitis occur more often in men than women. Chronic pancreatitis is inflammation of the pancreas that does not heal or improve-it gets worse over time and leads to permanent damage. Chronic pancreatitis, like acute pancreatitis, occurs when digestive enzymes attack the pancreas and nearby tissues, causing episodes of pain. Chronic pancreatitis often develops in people who are between the ages of 30 and 40. The most common cause of chronic pancreatitis is many years of heavy alcohol use. The chronic form of pancreatitis can be triggered by one acute attack that damages the pancreatic duct. The damaged duct causes the pancreas to become inflamed. Scar tissue develops and the pancreas is slowly destroyed. Other causes of chronic pancreatitis are: cystic fibrosis-the most com Continue reading >>
Transplantation Of The Pancreas
Division of General and Transplant Surgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa Division of Metabolism and Cell Transplantation, Azienda Ospedaliero Universitaria Pisana, University of Pisa Division of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Pisana, University of Pisa Division of General and Transplant Surgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa Division of Metabolism and Cell Transplantation, Azienda Ospedaliero Universitaria Pisana, University of Pisa Division of General and Transplant Surgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa Transplantation of an immediately vascularized pancreas allograft is the only therapy that consistently restores insulin independence in beta-cell deficient patients with diabetes. However, because of the risks associated with the transplant procedure and the need for life-long immunosuppression, pancreas transplantation is a therapeutic option only for a selected group of patients. Based on renal function, pancreas transplantation can be pursued in three different recipient categories: uremic patients, post-uremic patients (after successful kidney transplantation), and non-uremic patients. Uremic patients should ideally receive a pancreas and a kidney in a single procedure (simultaneous kidney-pancreas transplantation). Post-uremic patients with good renal reserve could receive a sequential pancreas transplant (pancreas after kidney transplantation). Non-uremic recipients may be eligible for a pancreas transplant alone if they face poor metabolic control, despite optimal insulin therapy, experience hypoglycemia unawareness and/or suffer from progressive chronic complications of diabetes. The results of pancreas transplantation are now excell Continue reading >>
Pancreas Transplantation For Type 2 Diabetes Mellitus: Who And Why?
In the past, type 2 diabetes mellitus (T2DM) was a contraindication for simultaneous pancreas-kidney transplantation (SPKT) even though it was generally accepted to be an effective treatment option for selected patients with type 1 DM (T1DM) and advanced chronic kidney disease. However, because there may be tremendous overlap in the clinical presentations of T1DM versus T2DM, the presence of detectable C-peptide is no longer considered reliable in determining DM “type.” Experiences with SPKT in uremic patients with detectable pretransplant C-peptide levels with a type 2 diabetes phenotype (older age of onset of DM and older age at transplant, shorter duration of insulin-requiring DM, higher body weight/BMI, higher proportion of African-Americans) have demonstrated outcomes equivalent to those with T1DM although clearly a more robust selection bias exists for patients with presumed T2DM. The success of SPKT in this setting provides evidence that the pathophysiology of T2DM is heterogeneous and not related exclusively to insulin resistance. The purpose of this review is to summarize evidence that appropriately selected uremic patients with T2DM may benefit from SPKT, with a focus on recipient selection in order to optimize outcomes. Exclusion criteria Age >65–70 years Non-insulin-requiring DM with absence of glucose hyperlability or progressive diabetic complications BMI >35 kg/m2 Insufficient cardiovascular functional reserve (one or more of the following): Coronary angiographic evidence of significant noncorrectable coronary artery disease, ejection fraction below 30–40 %, recent history of myocardial infarction or congestive heart failure, right ventricular end diastolic pressure >45–50 mmHg Moderate to severe dysfunction in other (nonrenal) organ system (lun Continue reading >>
- Insulin, glucagon and somatostatin stores in the pancreas of subjects with type-2 diabetes and their lean and obese non-diabetic controls
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Fatty Pancreas and the Development of Type 2 Diabetes
