Der Gastroenterologe

, 4:540 | Cite as

Pankreastransplantation

Schwerpunkt
  • 73 Downloads

Zusammenfassung

Die klinische Pankreastransplantation ist ein hoch effektives Verfahren zur Wiederherstellung der physiologischen Blutzuckerkontrolle bei Diabetikern. Im Gegensatz zur Inselzelltransplantation können für die Mehrzahl der Patienten Langzeitinsulinfreiheiten von deutlich mehr als 5 Jahren erreicht werden. Die simultane Pankreas-Nieren-Transplantation ist die Therapie der Wahl in der Behandlung von Typ-I-Diabetikern mit terminaler Niereninsuffizienz. Sie führt zu einer Verdreifachung der Lebenserwartung verglichen mit Patienten auf der Warteliste. Dies wird im Wesentlichen auf eine Reduktion der kardiovaskulären Mortalität zurückgeführt. Der vorliegende Artikel beschreibt die Pankreastransplantation im Hinblick auf Indikationen, Timing, chirurgische Technik, Komplikationen und Ergebnisse.

Schlüsselwörter

Isolierte Pankreastransplantation Pankreas- nach Nierentransplantation Simultane Pankreas-Nieren-Transplantation Blutzuckerkontrolle Lebensqualität 

Pancreas transplantation

Abstract

Pancreas transplantation is an effective and highly successful procedure for restoring physiological glucose control in diabetics. In contrast to islet transplantation, long-term results beyond 5 years can be achieved for the majority of patients. Simultaneous pancreas and kidney transplantation is the therapy of choice for type 1 diabetics with end-stage renal failure. This procedure leads to a threefold longer life expectancy compared with patients on the waiting list. These results are mainly due to a decreased mortality rate from cardiovascular events. This article reviews the indications, timing, surgical technique, complications, and results of pancreas transplantation.

Keywords

Pancreas transplant alone Pancreas after kidney transplant Simultaneous pancreas-kidney transplant Glucose control Quality of life 

Notes

Interessenkonflikt

Keine Angaben.

Literatur

  1. 1.
    UK Prospective Diabetes Study (UKPDS) Group (1998) Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352: 837–853CrossRefGoogle Scholar
  2. 2.
    The Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329: 977–986CrossRefGoogle Scholar
  3. 3.
    Shapiro AM, Ricordi C, Hering BJ et al (2006) International trial of the Edmonton protocol for islet transplantation. N Engl J Med 355: 1318–1330CrossRefPubMedGoogle Scholar
  4. 4.
    Ryan EA, Paty BW, Senior PA et al (2005) Five-year follow-up after clinical islet transplantation. Diabetes 54: 2060–2069CrossRefPubMedGoogle Scholar
  5. 5.
    American Diabetes Association (1992) Pancreas transplantation for patients with diabetes mellitus. Diabetes care 15: 1668–1672Google Scholar
  6. 6.
    White SA, Shaw JA, Sutherland DE (2009) Pancreas transplantation. Lancet 373: 1808–1817CrossRefPubMedGoogle Scholar
  7. 7.
    Scalea JR, Butler CC, Munivenkatappa RB et al (2008) Pancreas transplant alone as an independent risk factor for the development of renal failure: a retrospective study. Transplantation 86: 1789–1794CrossRefPubMedGoogle Scholar
  8. 8.
    Kleinclauss F, Fauda M, Sutherland DE et al (2009) Pancreas after living donor kidney transplants in diabetic patients: impact on long-term kidney graft function. Clin Transplant 23: 437–446CrossRefPubMedGoogle Scholar
  9. 9.
    Gruessner RW, Sutherland DE, Drangstveit MB et al (2008) Pancreas allotransplants in patients with a previous total pancreatectomy for chronic pancreatitis. J Am Coll Surg 206: 458–465CrossRefPubMedGoogle Scholar
  10. 10.
    Drognitz O, Benz S, Pfeffer F et al (2004) Long-term follow-up of 78 simultaneous pancreas-kidney transplants at a single-center institution in Europe. Transplantation 78: 1802–1808CrossRefPubMedGoogle Scholar
  11. 11.
    Ramanathan V, Goral S, Tanriover B et al (2005) Screening asymptomatic diabetic patients for coronary artery disease prior to renal transplantation. Transplantation 79: 1453–1458CrossRefPubMedGoogle Scholar
  12. 12.
    Odorico JS, Heisey DM, Voss BJ et al (1998) Donor factors affecting outcome after pancreas transplantation. Transplant Proc 30: 276–277CrossRefPubMedGoogle Scholar
  13. 13.
    Salvalaggio PR, Schnitzler MA, Abbott KC et al (2007) Patient and graft survival implications of simultaneous pancreas kidney transplantation from old donors. Am J Transplant 7: 1561–1571CrossRefPubMedGoogle Scholar
  14. 14.
    Vinkers MT, Rahmel AO, Slot MC et al (2008) How to recognize a suitable pancreas donor: a Eurotransplant study of preprocurement factors. Transplant Proc 40: 1275–1278CrossRefPubMedGoogle Scholar
  15. 15.
    Hopt UT, Busing M, Schareck WD, Becker HD (1992) The management of exocrine pancreatic secretion: a central problem of allogeneic pancreas transplantation. Chirurg 63: 186–192PubMedGoogle Scholar
  16. 16.
    Nghiem DD, Corry RJ (1987) Technique of simultaneous renal pancreatoduodenal transplantation with urinary drainage of pancreatic secretion. Am J Surg 153: 405–406CrossRefPubMedGoogle Scholar
  17. 17.
    Gruessner AC, Sutherland DE (2005) Pancreas transplant outcomes for United States (US) and non-US cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR) as of June 2004. Clin Transplant 19: 433–455CrossRefPubMedGoogle Scholar
  18. 18.
    Gaber AO, Shokouh-Amiri H, Grewal HP, Britt LG (1993) A technique for portal pancreatic transplantation with enteric drainage. Surg Gynecol Obstet 177: 417–419PubMedGoogle Scholar
  19. 19.
    Pfeffer F, Nauck MA, Erb M et al (1997) Absence of severe hyperinsulinemia after pancreas/kidney transplantation with peripheral venous drainage. Transplant Proc 29: 645–646CrossRefPubMedGoogle Scholar
  20. 20.
    Fontbonne A, Charles MA, Thibult N et al (1991) Hyperinsulinaemia as a predictor of coronary heart disease mortality in a healthy population: the Paris Prospective Study, 15-year follow-up. Diabetologia 34: 356–361CrossRefPubMedGoogle Scholar
  21. 21.
    Hummel R, Langer M, Wolters HH et al (2008) Exocrine drainage into the duodenum: a novel technique for pancreas transplantation. Transpl Int 21: 178–181PubMedGoogle Scholar
  22. 22.
    Saudek F, Malaise J, Boucek P, Adamec M (2005) Efficacy and safety of tacrolimus compared with cyclosporin microemulsion in primary SPK transplantation: 3-year results of the Euro-SPK 001 trial. Nephrol Dial Transplant 20(Suppl 2): ii3–ii10, ii62CrossRefPubMedGoogle Scholar
  23. 23.
    Stratta RJ, Gaber AO, Shokouh-Amiri MH et al (1999) Evolution in pancreas transplantation techniques: simultaneous kidney-pancreas transplantation using portal-enteric drainage without antilymphocyte induction. Ann Surg 229: 701–708CrossRefPubMedGoogle Scholar
  24. 24.
    Malaise J, Nakache R, Kahl A et al (2005) Corticosteroid withdrawal in simultaneous pancreas-kidney transplantation: a 3-year report. Transplant Proc 37: 2853–2855CrossRefPubMedGoogle Scholar
  25. 25.
    Cantarovich D, Vistoli F (2009) Minimization protocols in pancreas transplantation. Transpl Int 22: 61–68CrossRefPubMedGoogle Scholar
  26. 26.
    Fernandez-Cruz L, Sabater L, Gilabert R et al (1993) Native and graft pancreatitis following combined pancreas-renal transplantation. Br J Surg 80: 1429–1432CrossRefPubMedGoogle Scholar
  27. 27.
    Benz S, Bergt S, Obermaier R et al (2001) Impairment of microcirculation in the early reperfusion period predicts the degree of graft pancreatitis in clinical pancreas transplantation. Transplantation 71: 759–763CrossRefPubMedGoogle Scholar
  28. 28.
    Goodman J, Becker YT (2009) Pancreas surgical complications. Curr Opin Organ Transplant 14: 85–89CrossRefPubMedGoogle Scholar
  29. 29.
    Sollinger HW, Odorico JS, Knechtle SJ et al (1998) Experience with 500 simultaneous pancreas-kidney transplants. Ann Surg 228: 284–296CrossRefPubMedGoogle Scholar
  30. 30.
    Shapiro R, Jordan ML, Scantlebury VP et al (2000) Renal allograft rejection with normal renal function in simultaneous kidney/pancreas recipients: does dissynchronous rejection really exist? Transplantation 69: 440–441CrossRefPubMedGoogle Scholar
  31. 31.
    Kaplan B, West-Thielke P, Herren H et al (2008) Reported isolated pancreas rejection is associated with poor kidney outcomes in recipients of a simultaneous pancreas kidney transplant. Transplantation 86: 1229–1233CrossRefPubMedGoogle Scholar
  32. 32.
    Smets YF, Westendorp RG, van der Pijl JW et al (1999) Effect of simultaneous pancreas-kidney transplantation on mortality of patients with type-1 diabetes mellitus and end-stage renal failure. Lancet 353: 1915–1919CrossRefPubMedGoogle Scholar
  33. 33.
    Tyden G, Bolinder J, Solders G et al (1999) Improved survival in patients with insulin-dependent diabetes mellitus and end-stage diabetic nephropathy 10 years after combined pancreas and kidney transplantation. Transplantation 67: 645–648CrossRefPubMedGoogle Scholar
  34. 34.
    Ojo AO, Meier-Kriesche HU, Hanson JA et al (2001) The impact of simultaneous pancreas-kidney transplantation on long-term patient survival. Transplantation 71: 82–90CrossRefPubMedGoogle Scholar
  35. 35.
    Pruijm MT, de Fijter HJ, Doxiadis II, Vandenbroucke JP (2006) Preemptive versus Non-preemptive simultaneous pancreas-kidney transplantation: a single-center, long-term, follow-up study. Transplantation 81: 1119–1124CrossRefPubMedGoogle Scholar
  36. 36.
    Ablorsu E, Ghazanfar A, Mehra S et al (2008) Outcome of pancreas transplantation in recipients older than 50 years: a single-centre experience. Transplantation 86: 1511–1514CrossRefPubMedGoogle Scholar
  37. 37.
    Weiss AS, Smits G, Wiseman AC (2009) Simultaneous pancreas-kidney versus deceased donor kidney transplant: can a fair comparison be made? Transplantation 87: 1402–1410CrossRefPubMedGoogle Scholar
  38. 38.
    Secchi A, Caldara R, La RE et al (1998) Cardiovascular disease and neoplasms after pancreas transplantation. Lancet 352: 65CrossRefPubMedGoogle Scholar
  39. 39.
    Venstrom JM, McBride MA, Rother KI et al (2003) Survival after pancreas transplantation in patients with diabetes and preserved kidney function. JAMA 290: 2817–2823CrossRefPubMedGoogle Scholar
  40. 40.
    Gruessner RW, Sutherland DE, Gruessner AC (2004) Mortality assessment for pancreas transplants. Am J Transplant 4: 2018–2026CrossRefPubMedGoogle Scholar
  41. 41.
    Hopt UT, Drognitz O (2000) Pancreas organ transplantation. Short and long-term results in terms of diabetes control. Langenbecks Arch Surg 385: 379–389CrossRefPubMedGoogle Scholar
  42. 42.
    Piehlmeier W, Bullinger M, Kirchberger I et al (1996) Evaluation of the quality of life of patients with insulin-dependent diabetes mellitus before and after organ transplantation with the SF 36 health survey. Eur J Surg 162: 933–940PubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  1. 1.Abt. Allgemein- und Viszeralchirurgie, Klinik und Poliklinik für ChirurgieUniversitätsklinikum FreiburgFreiburg im BreisgauDeutschland

Personalised recommendations