Kidney-Pancreas Transplant

Objectives:The present study was designed to explore the protective
effect of  Cassia auriculata  L. flower extract (CAE) in high fat diet
and streptozotocin induced type 2 diabetic (T2DM) rats.
Methods:T2DM was induced by a combination of high fat dietand
low  dose  streptozocin.  Rats  in  different  groups  were  treated  with
Cassia auriculata L. flower extract at two different doses viz. 300mg
and 500mg/Kg body weight and the hypoglycemic potential as well
as  lipid  lowering  and  antioxidant  properties  of  CAE in  liver  and
pancreas were evaluated.
Results:  T2DM  rats  showed  significantly  elevated  glucose  and
reduced c-peptide levels in serum. Also there was significant increase
in  serum  marker  enzymes  of  liver  toxicity-alanine  transaminase
(SGPT),  aspartate  transaminase  (SGOT)  and  alkaline  phosphatase
(ALP) along with significant reduction in liver glycogen and increase
in  lipid  peroxidation  levels.  There  was  also  deregulation  in  lipid
levels  in  plasma  and  liver  and  significant  reduction  in  antioxidant
enzymes  in  plasma,  liver  and  pancreas.  Encouragingly,  treatment
with Cassia auriculata extract caused significant improvement in the
glucose, insulin, lipid levels in plasma and the antioxidant status of
liver and pancreas.
Conclusion: Out  of  the  two  doses  of  CAE  used  in  this  study,
500mg/kg b.w dose was found to be more effective inregulating the
levels of antioxidants and lipid levels in plasma,  liver and pancreas
indicating its potential to ameliorate peripheral insulin resistance.

Pancreas transplantation has become accepted as the only definitive long-term treatment that reliably restores euglycemia by restoring endogenous insulin production and improving glucose counterregulation in patients with type 1 diabetes mellitus and in carefully selected patients with insulin-dependent type 2 diabetes mellitus. Despite five decades of experience and with more than 41,000 pancreas transplants performed worldwide through 2011, a multitude of variations exist in operative technique, reflecting the lack of consensus regarding the best method for implanting a pancreas allograft into a recipient. These differences in technique are primarily related to the method of pancreatic exocrine secretion drainage and the site of portal-venous drainage. The surgical technique of pancreas transplantation has evolved over time in response to technical complications and physiologic derangements associated with earlier methods of implantation. This chapter reviews the historical development of the pancreas transplant technique and elaborates on the rationale for the different variations currently practiced. Detailed descriptions of the most common technical approaches to implantation are provided.
Keywords
Pancreas transplantation Technique Systemic-enteric drainage Systemic-bladder drainage Portal- enteric drainage

Improving monitoring after pancreas transplantation alone: fine-tuning of an old technique Voskuil MD, Mittal S, Sharples EJ, Vaidya A, Gilbert J, Friend PJ, Ploeg RJ. Improving monitoring after pancreas transplantation alone: fine-tuning of an old technique.

Pancreas Risk Outcomes a b s t r a c t Background: A pancreas donor risk index (PDRI) has been derived by Axelrod et al. to inform organ acceptance and developed into a smartphone app by Marc Melcher. This paper aims to validate the app for use in a single UK transplant center through a snapshot of donors and outcomes during one calendar year. Methods: Donor details for all pancreas transplants performed in 2011 were collected from a prospectively maintained clinical database to calculate a PDRI using the Pancreas Transplant Donor Risk Index smartphone app. Results: Ninety pancreas transplants were included in the analysis (72 simultaneous pancreas kidney [SPK], 18 pancreas transplant alone [PTA]). PDRI scores were found to be positively skewed compared with donors described in the US literature. The PDRI was predictive of poorer 1-y graft outcome in the SPK group but not in the PTA group. PDRI was not predictive of time to failure or failure cause.

The aim of this study is to report our six-year experience with portal-endocrine and gastric-exocrine drainage technique of pancreatic transplantation, which was first developed and implemented at our center in 2007. In this study, the outcomes of all patients at our center who had pancreas transplantation with portal-endocrine and gastric-exocrine drainage technique were evaluated. From October 2007 to November 2013, 38 patients had pancreas transplantation with this technique - 31 simultaneous kidney pancreas and seven pancreas alone. Median duration of follow-up was 3.8 years. One-, three-, and five-year patient and graft survival rates were 94%, 87%, 70% and 83%, 65%, 49%, respectively. For pancreas allograft dysfunction evaluation, 51 upper endoscopies were performed in 14 patients; donor duodenal biopsies were successfully obtained in 45 (88%). We detected nine episodes of acute rejection (eight patients) and seven episodes of cytomegalovirus (CMV) duodenitis (six patients). N...

BACKGROUND The aim of this study is to report our six-year experience with portal-endocrine and gastric-exocrine drainage technique of pancreatic transplantation, which was first developed and implemented at our center in 2007. METHODS In this study, the outcomes of all patients at our center who had pancreas transplantation with portal-endocrine and gastric-exocrine drainage technique were evaluated. RESULTS From October 2007 to November 2013, 38 patients had pancreas transplantation with this technique - 31 simultaneous kidney pancreas and seven pancreas alone. Median duration of follow-up was 3.8 years. One-, three-, and five-year patient and graft survival rates were 94%, 87%, 70% and 83%, 65%, 49%, respectively. For pancreas allograft dysfunction evaluation, 51 upper endoscopies were performed in 14 patients; donor duodenal biopsies were successfully obtained in 45 (88%). We detected nine episodes of acute rejection (eight patients) and seven episodes of cytomegalovirus (CMV) d...

At present, pancreas transplantations are usually performed in persons with insulin-dependent diabetes
with end-stage renal disease. Patients who have undergone single pancreas or combined kidney-pancreas
transplantation, often require post-operative treatment in Intensive Care Units since complications such
as thrombosis, pancreatitis, infections, bleeding, rejection and toxicity from immunosuppressive agents
may compromise their final outcome. Islet transplantation on the other hand, is an evolving therapy, and
has not yet achieved its potential for reliably effective treatment of patients with severe hypoglycemia or
labile type 1 diabetes.

Background: The aim of this study is to report our six-year experience with portal-endocrine and gastric-exocrine drainage technique of pancreatic transplantation, which was first developed and implemented at our center in 2007. Methods: In this study, the outcomes of all patients at our center who had pancreas transplantation with portal-endocrine and gastric-exocrine drainage technique were evaluated. Results: From October 2007 to November 2013, 38 patients had pancreas transplantation with this technique -31 simultaneous kidney pancreas and seven pancreas alone. Median duration of follow-up was 3.8 years. One-, three-, and five-year patient and graft survival rates were 94%, 87%, 70% and 83%, 65%, 49%, respectively. For pancreas allograft dysfunction evaluation, 51 upper endoscopies were performed in 14 patients; donor duodenal biopsies were successfully obtained in 45 (88%). We detected nine episodes of acute rejection (eight patients) and seven episodes of cytomegalovirus (CMV)...

Abstract:  Pancreas graft loss due to venous thrombosis is the leading non-immunological cause for graft failure following kidney–pancreas transplantation. Thromboelastography (TEG)-directed anticoagulation protocol has shown that approximately one-third of the patients undergoing pancreas transplantation require therapeutic anticoagulation to prevent the occurrence of graft thrombosis. This article presents the argument for individualised anticoagulation in these patients based on their TEG tracings and suggests the use of TEG in patients undergoing pancreas transplantation.