OBJECTIVE: This study was designed to evaluate the results of solitary pancreas transplantation in a protocol that uses the new immunosuppressant tacrolimus (FK) and liberally applies ultrasound-guided percutaneous pancreas biopsy to diagnose rejection. SUMMARY BACKGROUND DATA: Pancreas graft survival in patients who simultaneously receive a kidney transplant (SPK) historically has been 75% to 90% at 1 year, approaching that of cadaveric kidney transplantations. In sharp contrast, graft survival rates in patients who receive a pancreas atone (PA) have remained static over the past decade, with approximately 50% functional at 1 year. It was hypothesized that the results of PA transplantations would improve with newer maintenance immunosuppressants and biopsy techniques. METHODS: Twenty-seven PA recipients prospectively were treated with FK-based immunosuppression (PA-FK). Percutaneous biopsy was performed for hyperamylasemia, hyperlipasemia, hypoamylasuria, or unexplained fever. One year pancreas graft survival in these patients was compared to 15 cyclosporine treated PA cases (PA-CsA) and 113 SPK recipients. RESULTS: The 1-year pancreas graft survival rate of 90.1% in technically successful PA-FK patients was significantly better than the 53.4% rate in PA-CsA recipients (p = 0.002) and no different than the 87.4% rate in SPK recipients. The only graft lost to acute rejection in the PA-FK group was because of acknowledged patient noncompliance. Percutaneous biopsy substantially improved the diagnostic certainty in cases of suspected rejection and was associated with a low complication rate (3/178 = 1.5%). CONCLUSIONS: Modern immunosuppression and biopsy techniques have improved the success of solitary pancreas transplantations to the point where outcome is now equivalent to that of SPKs.
OBJECTIVE: This study was designed to evaluate the results of solitary pancreas transplantation in a protocol that uses the new immunosuppressant tacrolimus (FK) and liberally applies ultrasound-guided percutaneous pancreas biopsy to diagnose rejection. SUMMARY BACKGROUND DATA: Pancreas graft survival in patients who simultaneously receive a kidney transplant (SPK) historically has been 75% to 90% at 1 year, approaching that of cadaveric kidney transplantations. In sharp contrast, graft survival rates in patients who receive a pancreas atone (PA) have remained static over the past decade, with approximately 50% functional at 1 year. It was hypothesized that the results of PA transplantations would improve with newer maintenance immunosuppressants and biopsy techniques. METHODS: Twenty-seven PA recipients prospectively were treated with FK-based immunosuppression (PA-FK). Percutaneous biopsy was performed for hyperamylasemia, hyperlipasemia, hypoamylasuria, or unexplained fever. One year pancreas graft survival in these patients was compared to 15 cyclosporine treated PA cases (PA-CsA) and 113 SPK recipients. RESULTS: The 1-year pancreas graft survival rate of 90.1% in technically successful PA-FKpatients was significantly better than the 53.4% rate in PA-CsA recipients (p = 0.002) and no different than the 87.4% rate in SPK recipients. The only graft lost to acute rejection in the PA-FK group was because of acknowledged patient noncompliance. Percutaneous biopsy substantially improved the diagnostic certainty in cases of suspected rejection and was associated with a low complication rate (3/178 = 1.5%). CONCLUSIONS: Modern immunosuppression and biopsy techniques have improved the success of solitary pancreas transplantations to the point where outcome is now equivalent to that of SPKs.
Authors: R E Nakhleh; E Benedetti; A Gruessner; C Troppmann; J J Goswitz; D E Sutherland; R W Gruessner Journal: Transplantation Date: 1995-09-27 Impact factor: 4.939
Authors: R W Gruessner; R Nakhleh; P Tzardis; R Schechner; A C Gruessner; A J Matas; J S Najarian; D E Sutherland Journal: Transplantation Date: 1994-03-15 Impact factor: 4.939
Authors: R J Stratta; R J Taylor; J S Bynon; J A Lowell; R Sindhi; T O Wahl; T F Knight; L G Weide; W C Duckworth Journal: Ann Surg Date: 1994-12 Impact factor: 12.969
Authors: M L Jordan; R Shapiro; C A Vivas; V P Scantlebury; P Rhandhawa; G Carrieri; J McCauley; A J Demetris; A Tzakis; J J Fung Journal: Transplantation Date: 1994-03-27 Impact factor: 4.939
Authors: A O Gaber; M H Shokouh-Amiri; D K Hathaway; L Hammontree; A E Kitabchi; L W Gaber; M F Saad; L G Britt Journal: Ann Surg Date: 1995-06 Impact factor: 12.969
Authors: E Benedetti; J S Najarian; A C Gruessner; R E Nakhleh; C Troppmann; N S Hakim; J Pirenne; D E Sutherland; R W Gruessner Journal: Surgery Date: 1995-11 Impact factor: 3.982
Authors: B Philosophe; A C Farney; E J Schweitzer; J O Colonna; B E Jarrell; V Krishnamurthi; A M Wiland; S T Bartlett Journal: Ann Surg Date: 2001-11 Impact factor: 12.969
Authors: D E Sutherland; R W Gruessner; D L Dunn; A J Matas; A Humar; R Kandaswamy; S M Mauer; W R Kennedy; F C Goetz; R P Robertson; A C Gruessner; J S Najarian Journal: Ann Surg Date: 2001-04 Impact factor: 12.969