BACKGROUND: A pancreas transplant alone (PTA) in a nonuremic patient with brittle diabetes mellitus remains a rare procedure because the tradeoff for insulin independence is lifelong immunosuppression. METHODS: Herein we report our results at the University of Minnesota of 513 PTAs from December 17, 1966, through December 31, 2006. Of these recipients, 87% had previously experienced hypoglycemic unawareness and 23% experienced coma and/or seizures. These transplants spanned four immunosuppressive eras: pre-cyclosporine A (pre-CsA) era (16%), CsA era (23%), tacrolimus (TAC) era (47%), and calcineurin-inhibitor (CNI)-free era (14%). RESULTS: The overall patient survival rate at 1 year posttransplant was about 95%; at 5 years, it was 90%. The pancreas graft survival rate at 1 year increased significantly from the pre-CsA era (31%) to the TAC era (75%), thanks to a significant decline in immunologic and technical failures. The CNI-free protocol, because of its high infection and hematologic infection rate, did not further improve outcome. Risk factors for subsequent kidney failure (13% at 5 years posttransplant) were serum creatinine levels>1.5 mg/dl at the time of the pancreas transplant and recipient age<30 years. CONCLUSIONS: A technically successful PTA is currently the only treatment option that allows nonuremic patients with brittle diabetes to become insulin-independent in the long term.
BACKGROUND: A pancreas transplant alone (PTA) in a nonuremic patient with brittle diabetes mellitus remains a rare procedure because the tradeoff for insulin independence is lifelong immunosuppression. METHODS: Herein we report our results at the University of Minnesota of 513 PTAs from December 17, 1966, through December 31, 2006. Of these recipients, 87% had previously experienced hypoglycemic unawareness and 23% experienced coma and/or seizures. These transplants spanned four immunosuppressive eras: pre-cyclosporine A (pre-CsA) era (16%), CsA era (23%), tacrolimus (TAC) era (47%), and calcineurin-inhibitor (CNI)-free era (14%). RESULTS: The overall patient survival rate at 1 year posttransplant was about 95%; at 5 years, it was 90%. The pancreas graft survival rate at 1 year increased significantly from the pre-CsA era (31%) to the TAC era (75%), thanks to a significant decline in immunologic and technical failures. The CNI-free protocol, because of its high infection and hematologic infection rate, did not further improve outcome. Risk factors for subsequent kidney failure (13% at 5 years posttransplant) were serum creatinine levels>1.5 mg/dl at the time of the pancreas transplant and recipient age<30 years. CONCLUSIONS: A technically successful PTA is currently the only treatment option that allows nonuremic patients with brittle diabetes to become insulin-independent in the long term.
Authors: J P Lindahl; A Hartmann; R Horneland; H Holdaas; A V Reisæter; K Midtvedt; T Leivestad; O Oyen; T Jenssen Journal: Diabetologia Date: 2013-04-03 Impact factor: 10.122
Authors: A D Barlow; M O Hamed; D H Mallon; R J Brais; F M Gribble; M A Scott; W J Howat; J A Bradley; E M Bolton; G J Pettigrew; S A Hosgood; M L Nicholson; K Saeb-Parsy Journal: Am J Transplant Date: 2015-05-18 Impact factor: 8.086
Authors: Franca B Barton; Michael R Rickels; Rodolfo Alejandro; Bernhard J Hering; Stephen Wease; Bashoo Naziruddin; Jose Oberholzer; Jon S Odorico; Marc R Garfinkel; Marlon Levy; Francois Pattou; Thierry Berney; Antonio Secchi; Shari Messinger; Peter A Senior; Paola Maffi; Andrew Posselt; Peter G Stock; Dixon B Kaufman; Xunrong Luo; Fouad Kandeel; Enrico Cagliero; Nicole A Turgeon; Piotr Witkowski; Ali Naji; Philip J O'Connell; Carla Greenbaum; Yogish C Kudva; Kenneth L Brayman; Meredith J Aull; Christian Larsen; Tom W H Kay; Luis A Fernandez; Marie-Christine Vantyghem; Melena Bellin; A M James Shapiro Journal: Diabetes Care Date: 2012-07 Impact factor: 19.112
Authors: Paolo R Salvalaggio; Nino Dzebisashvili; Brett Pinsky; Mark A Schnitzler; Thomas E Burroughs; Ralph Graff; David A Axelrod; Daniel C Brennan; Krista L Lentine Journal: Diabetes Care Date: 2009-01-08 Impact factor: 17.152