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Do Pancreas Transplants Exist?

Pancreas Transplantation

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, [email protected] 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

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 >>

Transplant Surgery - Chronic Pancreatitis

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 >>

Association Between The Pancreas Transplantation And Survival Of Patients With Diabetes: A Single Center Experience

Association Between The Pancreas Transplantation And Survival Of Patients With Diabetes: A Single Center Experience

Association between the pancreas transplantation and survival of patients with diabetes: A single center experience Contributed equally to this work with: Ji Yoon Choi, Joo Hee Jung, Sung Shin, Young Hoon Kim, Duck Jong Han Roles Conceptualization, Data curation, Formal analysis, Writing original draft, Writing review & editing Affiliation Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea Contributed equally to this work with: Ji Yoon Choi, Joo Hee Jung, Sung Shin, Young Hoon Kim, Duck Jong Han Affiliation Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea Contributed equally to this work with: Ji Yoon Choi, Joo Hee Jung, Sung Shin, Young Hoon Kim, Duck Jong Han Roles Conceptualization, Data curation Affiliation Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea Contributed equally to this work with: Ji Yoon Choi, Joo Hee Jung, Sung Shin, Young Hoon Kim, Duck Jong Han Roles Conceptualization, Data curation, Formal analysis, Supervision Affiliation Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea Contributed equally to this work with: Ji Yoon Choi, Joo Hee Jung, Sung Shin, Young Hoon Kim, Duck Jong Han Roles Conceptualization, Data curation, Formal analysis, Methodology, Supervision, Writing original draft, Writing review & editing Continue reading >>

Pancreas Transplantation For Type 1 Diabetes A Summation

Pancreas Transplantation For Type 1 Diabetes A Summation

The Journal of Clinical Endocrinology & Metabolism Pancreas Transplantation for Type 1 Diabetes A Summation Pacific Northwest Research Foundation and Division of Metabolism, Endocrinology, and Nutrition University of Washington, Seattle, Washington 98122 Search for other works by this author on: Chief of Patient Care Services Veterans Health Administration Department of Veterans Affairs Washington, DC 20420 Search for other works by this author on: Division of Endocrinology Mt. Sinai Health Care System Case Western Reserve University Cleveland, Ohio 44106-4198 Search for other works by this author on: The Journal of Clinical Endocrinology & Metabolism, Volume 83, Issue 6, 1 June 1998, Pages 18681874, R. Paul Robertson, Thomas V. Holohan, Saul Genuth; Pancreas Transplantation for Type 1 Diabetes A Summation, The Journal of Clinical Endocrinology & Metabolism, Volume 83, Issue 6, 1 June 1998, Pages 18681874, Has Pancreatic Transplantation Arrived as a Therapeutic Option in IDDM? Simple and Circumspect Answers FROM my point of view, there are two responses to this important clinical questionthe simple one and a circumspect one. The simple answer is yes. In one respect this question is a nonquestion because pancreases are being transplanted therapeutically all over the United States and Europe on a daily basis. Over 1200 pancreases were provided to insulin-dependent melitus (IDDM) diabetic patients at transplant centers throughout the world in 1997, and almost 10,000 have been transplanted since the procedure became feasible in 1978 ( 1 ). Most frequently, pancreases are transplanted simultaneously with kidneys in patients who have renal failure and who have had IDDM for greater than 20 yr. After establishment of initial immunosuppression, their daily drug regimen usually Continue reading >>

Umn To Celebrate 50th Anniversary Of Pancreatic Transplant

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 >>

Pre-kidney Pancreas Transplant Preparation | Upmc

Pre-kidney Pancreas Transplant Preparation | Upmc

Before Your Kidney or Pancreas Transplant Early referral for a kidney or pancreas pretransplant evaluation is very important. Provide comprehensive assessments for your transplant. Identify any potential issues and avoid possible complications. Your pretransplant evaluation will take place, at the Thomas E. Starzl Transplantation Institute at UPMC Montefiore. You will not be admitted as an inpatient for evaluation instead you will be coming in for appointments. In most cases, you or your referring doctor can schedule your evaluation within 72 hours of insurance approval. What to Expect During Your Pretransplant Evaluation Your kidney transplant evaluation will last three to five days. You will need to bring a caregiver or support person with you to each appointment. If you don't live near Pittsburgh, Family House offers affordable lodging for transplant patients and their loved ones. During your evaluation, the transplant team will conduct tests and blood work to make sure kidney transplant is right for you. When you arrive at UPMC, your kidney transplant coordinator will: Give you aninformationalpacket with details about the kidney transplant process and what you should expect before, during, and after your transplant. You will need to keep this with you during your visit. Explain your kidney transplant evaluation schedule. Let you know where your tests and consults will take place. While you're here, you will meet with members of the transplant team, including your: Nephrologist (kidney physician) who will examine you and review your history to assess your kidney disease. He or she may also go over other treatment options for managing your kidney disease without a transplant, if they exist. Kidney transplant surgeon, who will assess your physical condition and look o Continue reading >>

Pancreas Transplant | Nebraska Medicine Omaha, Ne

Pancreas Transplant | Nebraska Medicine Omaha, Ne

Has life with Type 1 Diabetes become a burden? Do you struggle with complications of Type 1 Diabetes? Can you imagine finally living life without daily insulin injections? For patients who are suffering from the complications of Type 1 diabetes, including kidney failure, our pancreas transplant team is here to help. When you visit the Transplant Center at Nebraska Medicine, members of our pancreas team will help determine your eligibility for a pancreas (and possible simultaneous kidney) transplant. As one of the first U.S. hospitals to perform this procedure, our outcomes continue to meet or exceed national standards. From the time you enter our doors to long after you return home from surgery, our dedicated team will be here to support you on your journey to better health. External Resources Nebraska Medicine's Pancreas Transplant Team Recommends The pancreas is a slender gland located between your stomach and spinal cord on the left side of the abdomen. This gland has two major functions: 1) to regulate your blood sugar by making insulin and glucagon; 2) to produce a digestive enzyme that is secreted into the small intestine (bowel) to help with digestion. If you have diabetes mellitus Type I, your pancreas is not making enough insulin to regulate your blood sugar. If you have diabetes, your doctor or the transplant center can conduct tests to determine whether you have Type I diabetes (not enough insulin) or Type 2 diabetes (your body is not able to use the insulin that is being made). You may be referred to an endocrinologist, a physician who specializes in diabetes who can provide further diagnosis, treatment and education about being diabetic. Diabetes mellitus is the leading cause of end-stage renal disease (ESRD) and accounts for approximately 40 percent of pa Continue reading >>

Pancreas Transplantation For Type 2 Diabetes Mellitus: Who And Why?

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 >>

Pancreas Transplantation

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 >>

Transplant Surgery - Pancreas Transplant

Transplant Surgery - Pancreas Transplant

Transplant Surgery Conditions & Procedures Pancreas Transplant The pancreas is an organ about the size of a hand located in the abdomen in the vicinity of the stomach, intestines, and other organs. It lies behind the stomach and in front of the spine. The pancreasproduces juices that help digest food andhormones such as insulin and glucagon that maintain optimal blood sugar levels and help the body to use and store energy from food. A pancreas transplant is an organ transplant that involves implanting a healthy pancreas (one that produces insulin) into a person whose pancreasno longer can supply sufficient insulin to the body.The healthy pancreascomes from either a deceased donor,orin the form ofa partial pancreas from a living donor. A pancreas transplant offers a potential cure fortype 1 or insulin-dependent diabetes. A successful pancreas transplant will eliminate the need for insulin injections, reduce or eliminate dietary and activity restrictions due to diabetes, and decrease or eliminate the risk of severe low blood sugar reactions. A pancreas transplant can also help manage thedamage to other organs including the kidneys that may result from type 1 diabetes. Pancreas transplants areprimarily offered topersons with type 1withseverekidney disease or other life-threatening consequencesfrom uncontrolled glucose levels.Type 1 diabetes is caused by a loss or malfunction of the insulin producing cells, called pancreatic beta cells. Beta cells ( cells) are a type of cell found in the pancreatic islets of the pancreas. They make up 65-80% of the cells in the islets. Patients withtype 2 diabetes are generally not offered pancreas transplants because their disease results from the body's inability to use insulin properly,notfrom an inability to produceininsulin in the pan 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 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

Pancreas Transplantation

Division of Organ Transplantation and Immunology Department of Surgery Pancreas transplantation is the only treatment for typeI diabetes that establishes an insulin-independent,euglycemic state; glycosylated hemoglobin levels arenormalized for as long as the graft functions. But thepenalty for constant normoglycemia is the need forimmunosuppression. Thus, for nonuremic patients, pancreastransplants are currently performed only when the problemsof diabetes are perceived to be more serious than thepotential side effects of the anti-rejection drugs requiredby transplantation. For uremic diabetic patients who need a kidneytransplant, the addition of a pancreas has become routine. Such patients are already obligated to immunosuppression,thus there is usually no reason not to make them insulin-independent as well as dialysis-free. Adding a Pancreas to a Kidney in Diabetic Transplant Recipients Since constant euglycemia is unachievable for diabeticpatients by any practical mode of exogenous insulinadministration, and since hypoglycemia is intolerable,chronic hyperglycemia (as documented by measurements ofglycosylated hemoglobin) is the norm. However, after yearsof debate, it has now been unequivocally shown that therates of development of neuropathy, retinopathy, andnephropathy are related to the degree to which glycemia iscontrolled. Complication secondary to dysmetabolism afflict the eyes, nerves, and kidneys of more than 50percent of the patients who have had diabetes more than 20years. A successful pancreas transplant, with the resultingachievement of euglycemia, significantly improves bothgeneral health and life expectancy. Thus, a rationale forpancreas transplantation, as a method of providing perfectmetabolic control, exists. Although one of the long-range goals of pan Continue reading >>

Pancreas Transplantation For Type 2 Diabetes Mellitus.

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 >>

Pancreas Transplantation

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 >>

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