Evolution in pancreas transplantation techniques

Simultaneous kidney- pancreas transplantation using portal-enteric drainage without antilymphocyte induction

Robert J. Stratta, A. Osama Gaber, M. Hosein Shokouh-Amiri, K. Sudhakar Reddy, Rita R. Alloway, M. Francesca Egidi, Hani P. Grewal, Lillian W. Gaber, Donna Hathaway

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Objective: To report initial experience with the combination of a novel technique of portal-enteric pancreas transplantation with newer immunosuppressive strategies that eliminate antilymphocyte induction therapy. Background A new surgical technique of pancreas transplantation has been developed with portal venous delivery of insulin and enteric drainage of the exocrine secretions (portal-enteric). The introduction of potent immunosuppressive agents may allow simultaneous kidney and pancreas transplants (SKPT) to be performed without antilymphocyte induction. Methods: From September 1996 to November 1998, the authors performed 28 primary SKPTs with portal-enteric drainage and no antilymphocyte induction. All patients received triple immunosuppression with tacrolimus, mycophenolate mofetil, and steroids. The study group had a mean age of 38 years and a mean preoperative duration of diabetes of 25 years. Four patients (14%) had prior kidney transplants. Results: All patients had immediate renal allograft function. Actual patient, kidney, and pancreas graft survival rates were 86%, 82%, and 82%, respectively, after a mean follow-up of 12 months. Four patients died, three as a result of cardiac events unrelated to SKPT. Five kidney and five pancreas grafts were lost; including five deaths with function and three cases of chronic rejection. The mean length of stay and total charges for the initial hospital stay were 12.5 days and $99,517. The mean number of readmissions was 2.9, and 10 patients (36%) had no readmissions. Six patients (21%) developed acute rejection, with five (18%) receiving antilymphocyte therapy. Seven patients (25%) underwent relaparotomy, including two (7%) for intraabdominal infection. Nine patients (32%) had major infections, including three (11%) with cytomegaloviral infection. Of the 24 surviving patients, 22 (92%) are both dialysis- and insulin-free. Conclusion: These preliminary results suggest that SKPT with portal-enteric drainage without antilymphocyte induction can be performed with excellent outcomes.

Original languageEnglish (US)
Pages (from-to)701-712
Number of pages12
JournalAnnals of surgery
Volume229
Issue number5
DOIs
StatePublished - May 1 1999

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Pancreas Transplantation
Kidney Transplantation
Drainage
Kidney
Pancreas
Transplants
Immunosuppressive Agents
Length of Stay
Insulin
Intraabdominal Infections
Mycophenolic Acid
Tacrolimus
Graft Survival
Infection
Immunosuppression
Allografts
Dialysis
Survival Rate
Steroids

All Science Journal Classification (ASJC) codes

  • Surgery

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Evolution in pancreas transplantation techniques : Simultaneous kidney- pancreas transplantation using portal-enteric drainage without antilymphocyte induction. / Stratta, Robert J.; Gaber, A. Osama; Shokouh-Amiri, M. Hosein; Reddy, K. Sudhakar; Alloway, Rita R.; Egidi, M. Francesca; Grewal, Hani P.; Gaber, Lillian W.; Hathaway, Donna.

In: Annals of surgery, Vol. 229, No. 5, 01.05.1999, p. 701-712.

Research output: Contribution to journalArticle

Stratta, Robert J. ; Gaber, A. Osama ; Shokouh-Amiri, M. Hosein ; Reddy, K. Sudhakar ; Alloway, Rita R. ; Egidi, M. Francesca ; Grewal, Hani P. ; Gaber, Lillian W. ; Hathaway, Donna. / Evolution in pancreas transplantation techniques : Simultaneous kidney- pancreas transplantation using portal-enteric drainage without antilymphocyte induction. In: Annals of surgery. 1999 ; Vol. 229, No. 5. pp. 701-712.
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abstract = "Objective: To report initial experience with the combination of a novel technique of portal-enteric pancreas transplantation with newer immunosuppressive strategies that eliminate antilymphocyte induction therapy. Background A new surgical technique of pancreas transplantation has been developed with portal venous delivery of insulin and enteric drainage of the exocrine secretions (portal-enteric). The introduction of potent immunosuppressive agents may allow simultaneous kidney and pancreas transplants (SKPT) to be performed without antilymphocyte induction. Methods: From September 1996 to November 1998, the authors performed 28 primary SKPTs with portal-enteric drainage and no antilymphocyte induction. All patients received triple immunosuppression with tacrolimus, mycophenolate mofetil, and steroids. The study group had a mean age of 38 years and a mean preoperative duration of diabetes of 25 years. Four patients (14{\%}) had prior kidney transplants. Results: All patients had immediate renal allograft function. Actual patient, kidney, and pancreas graft survival rates were 86{\%}, 82{\%}, and 82{\%}, respectively, after a mean follow-up of 12 months. Four patients died, three as a result of cardiac events unrelated to SKPT. Five kidney and five pancreas grafts were lost; including five deaths with function and three cases of chronic rejection. The mean length of stay and total charges for the initial hospital stay were 12.5 days and $99,517. The mean number of readmissions was 2.9, and 10 patients (36{\%}) had no readmissions. Six patients (21{\%}) developed acute rejection, with five (18{\%}) receiving antilymphocyte therapy. Seven patients (25{\%}) underwent relaparotomy, including two (7{\%}) for intraabdominal infection. Nine patients (32{\%}) had major infections, including three (11{\%}) with cytomegaloviral infection. Of the 24 surviving patients, 22 (92{\%}) are both dialysis- and insulin-free. Conclusion: These preliminary results suggest that SKPT with portal-enteric drainage without antilymphocyte induction can be performed with excellent outcomes.",
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AU - Reddy, K. Sudhakar

AU - Alloway, Rita R.

AU - Egidi, M. Francesca

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AU - Gaber, Lillian W.

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