Selection and Preparation of the Pancreas Transplant Recipient

Chapter
Part of the Current Clinical Urology book series (CCU)

Abstract

Careful selection of appropriate pancreas transplant candidates is essential in order to maintain good patient and graft survival. As more complex patients are referred with increasing acceptance of this procedure, meticulous evaluation of potential candidates and their careful preparation prior to transplantation will also become increasingly necessary to maintain excellent outcomes. This chapter is devoted to the identification of candidates for pancreas transplantation and determination of the type of procedure that is most suitable. Additionally, a practical clinical, laboratory and preoperative evaluation protocol to optimize patients for pancreas transplantation is presented.

Keywords

Pretransplant evaluation Pancreas transplantation Type 1 diabetes mellitus 

References

  1. 1.
    Singh RP, Stratta RJ. Advances in immunosuppression for pancreas transplantation. Curr Opin Organ Transplant 2008;13(1):79–84.PubMedCrossRefGoogle Scholar
  2. 2.
    Humar A, Kandaswamy R, Granger D, Gruessner RW, Gruessner AC, Sutherland DE. Decreased surgical risks of pancreas transplantation in the modern era. Ann Surg 2000;231(2):269–275.PubMedCrossRefGoogle Scholar
  3. 3.
    Gruessner AC, Sutherland DE. 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 2005;19(4):433–455.PubMedCrossRefGoogle Scholar
  4. 4.
    Cohen DJ, St Martin L, Christensen LL, Bloom RD, Sung RS. Kidney and pancreas transplantation in the United States, 1995–2004. Am J Transplant 2006;6(5 Pt 2):1153–1169.PubMedCrossRefGoogle Scholar
  5. 5.
    American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2008;31(Suppl 1):S55–60.CrossRefGoogle Scholar
  6. 6.
    Gjessing HJ, Matzen LE, Faber OK, Froland A. Fasting plasma C-peptide, glucagon stimulated plasma C-peptide, and urinary C-peptide in relation to clinical type of diabetes. Diabetologia 1989;32(5):305–311.PubMedCrossRefGoogle Scholar
  7. 7.
    Esmatjes E, Fernandez C, Rueda S, Nicolau J, Chiganer G, Ricart MJ, et al. The utility of the C-peptide in the phenotyping of patients candidates for pancreas transplantation. Clin Transplant 2007;21(3):358–362.PubMedCrossRefGoogle Scholar
  8. 8.
    Covic AM, Schelling JR, Constantiner M, Iyengar SK, Sedor JR. Serum C-peptide concentrations poorly phenotype type 2 diabetic end-stage renal disease patients. Kidney Int 2000;58(4):1742–1750.PubMedCrossRefGoogle Scholar
  9. 9.
    Nath DS, Gruessner AC, Kandaswamy R, Gruessner RW, Sutherland DE, Humar A. Outcomes of pancreas transplants for patients with type 2 diabetes mellitus. Clin Transplant 2005;19(6):792–797.PubMedCrossRefGoogle Scholar
  10. 10.
    Meloche RM. Transplantation for the treatment of type 1 diabetes. World J Gastroenterol. 2007;13(47):6347–6355.PubMedCrossRefGoogle Scholar
  11. 11.
    Paramesh AS, Zhang R, Fonseca V, Killackey MT, Alper B, Slakey D, et al. Pancreas transplantation – a controversy in evolution. J La State Med Soc 2007;159(6):319, 323, 325–329.PubMedGoogle Scholar
  12. 12.
    Dafoe DC, Vinik AI. Is pancreas transplantation for insulin-dependent diabetes mellitus worthwhile? NEJM 1990;322(22):1608–1609.PubMedCrossRefGoogle Scholar
  13. 13.
    Nathan DM. Long-term complications of diabetes mellitus. NEJM 1993;328(23):1676–1685.PubMedCrossRefGoogle Scholar
  14. 14.
    Robertson RP, Davis C, Larsen J, Stratta R, Sutherland DE. Pancreas and islet transplantation for patients with diabetes. Diabetes Care 2000;23(1):112–116.PubMedCrossRefGoogle Scholar
  15. 15.
    Robertson RP, Davis C, Larsen J, Stratta R, Sutherland DE, American Diabetes Association. Pancreas and islet transplantation in type 1 diabetes. Diabetes Care 2006;29(4):935.PubMedCrossRefGoogle Scholar
  16. 16.
    Gruessner RW, Sutherland DE, Drangstveit MB, Kandaswamy R, Gruessner AC. Pancreas allotransplants in patients with a previous total pancreatectomy for chronic pancreatitis. J Am Coll Surg 2008;206(3):458–465.PubMedCrossRefGoogle Scholar
  17. 17.
    Fridell JA, Saxena R, Chalasani NP, Goggins WC, Powelson JA, Cummings OW. Complete reversal of glycogen hepatopathy with pancreas transplantation: two cases. Transplantation 2007;83(1):84–86.PubMedCrossRefGoogle Scholar
  18. 18.
    Oh HK, Provenzano R, Hendrix J, el-Nachef MW. Insulin allergy resolution following pancreas transplantation alone. Clin Transplant 1998;12(6): 593–595.PubMedGoogle Scholar
  19. 19.
    Becker BN, Odorico JS, Becker YT, Groshek M, Werwinski C, Pirsch JD, et al. Simultaneous pancreas-kidney and pancreas transplantation. J Am Soc Nephrol 2001;12(11):2517–2527.PubMedGoogle Scholar
  20. 20.
    Elkhammas EA, Henry ML, Ferguson RM, Bumgardner GL, Pelletier RP, Rajab A, et al. Simultaneous pancreas-kidney transplantation: overview of the Ohio State experience. Yonsei Med J 2004;45(6):1095–1100.PubMedGoogle Scholar
  21. 21.
    Rayhill SC, D’Alessandro AM, Odorico JS, Knechtle SJ, Pirsch JD, Heisey DM, et al. Simultaneous pancreas-kidney transplantation and living related donor renal transplantation in patients with diabetes: Is there a difference in survival? Ann Surg 2000;231(3):417–423.PubMedCrossRefGoogle Scholar
  22. 22.
    Bunnapradist S, Cho YW, Cecka JM, Wilkinson A, Danovitch GM. Kidney allograft and patient survival in type I diabetic recipients of cadaveric kidney alone versus simultaneous pancreas kidney transplants: a multivariate analysis of the UNOS database. J Am Soc Nephrol 2003;14(1):208–213.PubMedCrossRefGoogle Scholar
  23. 23.
    Gutierrez P, Marrero D, Hernandez D, Vivancos S, Perez-Tamajon L, Rodriguez de Vera JM, et al. Surgical complications and renal function after kidney alone or simultaneous pancreas-kidney transplantation: a matched comparative study. Nephrol Dial Transpl 2007;22(5):1451–1455.CrossRefGoogle Scholar
  24. 24.
    Douzdjian V, Rice JC, Gugliuzza KK, Fish JC, Carson RW. Renal allograft and patient outcome after transplantation: Pancreas-kidney versus kidney-alone transplants in type 1 diabetic patients versus kidney-alone transplants in nondiabetic patients. Am J Kidney Dis 1996;27(1):106–116.PubMedCrossRefGoogle Scholar
  25. 25.
    Manske CL, Wang Y, Thomas W. Mortality of cadaveric kidney transplantation versus combined kidney-pancreas transplantation in diabetic patients. Lancet 1995;346(8991–8992):1658–1662.PubMedCrossRefGoogle Scholar
  26. 26.
    United Network for Organ Sharing. 2007 U.S organ procurement and transplantation network/scientific registry of transplant recipients: Transplant data 1997–2006. 2008.Google Scholar
  27. 27.
    Hariharan S, Pirsch JD, Lu CY, Chan L, Pesavento TE, Alexander S, et al. Pancreas after kidney transplantation. J Am Soc Nephrol 2002;13(4):1109–1118.PubMedGoogle Scholar
  28. 28.
    Larson TS, Bohorquez H, Rea DJ, Nyberg SL, Prieto M, Sterioff S, et al. Pancreas-after-kidney transplantation: an increasingly attractive alternative to simultaneous pancreas-kidney transplantation. Transplantation 2004;77(6):838–843.PubMedCrossRefGoogle Scholar
  29. 29.
    Humar A, Ramcharan T, Kandaswamy R, Matas A, Gruessner RW, Gruessner AC, et al. Pancreas after kidney transplants. Am J Surg 2001;182(2):155–161.PubMedCrossRefGoogle Scholar
  30. 30.
    Douzdjian V, Escobar F, Kupin WL, Venkat KK, Abouljoud MS. Cost-utility analysis of living-donor kidney transplantation followed by pancreas transplantation versus simultaneous pancreas-kidney transplantation. Clin Transplant 1999;13(1 Pt 1):51–58.PubMedCrossRefGoogle Scholar
  31. 31.
    Gruessner RW, Sutherland DE, Gruessner AC. Mortality assessment for pancreas transplants. Am J Transplant 2004;4(12):2018–2026.PubMedCrossRefGoogle Scholar
  32. 32.
    Humar A, Sutherland DE, Ramcharan T, Gruessner RW, Gruessner AC, Kandaswamy R. Optimal timing for a pancreas transplant after a successful kidney transplant. Transplantation 2000;70(8):1247–1250.PubMedCrossRefGoogle Scholar
  33. 33.
    Brennan DC, Stratta RJ, Lowell JA, Miller SA, Taylor RJ. Cyclosporine challenge in the decision of combined kidney-pancreas versus solitary pancreas transplantation. Transplantation 1994;57(11):1606–1610.PubMedGoogle Scholar
  34. 34.
    Lane JT, Ratanasuwan T, MackShipman LR, Taylor RJ, Leone JP, Miller SA, et al. Cyclosporine challenge test revisited: Does it predict outcome after solitary pancreas transplantation? Clin Transplant 2001;15(1):28–31.PubMedCrossRefGoogle Scholar
  35. 35.
    Larsen JL. Pancreas transplantation: Indications and consequences. Endocr Rev 2004;25(6):919–946.PubMedCrossRefGoogle Scholar
  36. 36.
    The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. NEJM 1993;329(14):977–986.Google Scholar
  37. 37.
    Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, Orchard TJ, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. NEJM 2005;353(25):2643–653.PubMedCrossRefGoogle Scholar
  38. 38.
    Dean PG, Kudva YC, Stegall MD. Long-term benefits of pancreas transplantation. Curr Opin Organ Transplant 2008;13(1):85–90.PubMedCrossRefGoogle Scholar
  39. 39.
    Humar A, Ramcharan T, Kandaswamy R, Gruessner RW, Gruessner AC, Sutherland DE. Technical failures after pancreas transplants: why grafts fail and the risk factors – a multivariate analysis. Transplantation 2004;78(8):1188–1192.PubMedCrossRefGoogle Scholar
  40. 40.
    Gruessner RW, Dunn DL, Gruessner AC, Matas AJ, Najarian JS, Sutherland DE. Recipient risk factors have an impact on technical failure and patient and graft survival rates in bladder-drained pancreas transplants. Transplantation 1994;57(11):1598–1606.PubMedGoogle Scholar
  41. 41.
    Troppmann C, Gruessner AC, Dunn DL, Sutherland DE, Gruessner RW. Surgical complications requiring early relaparotomy after pancreas transplantation: A multivariate risk factor and economic impact analysis of the cyclosporine era. Ann Surg 1998;227(2):255–268.PubMedCrossRefGoogle Scholar
  42. 42.
    Kasiske BL, Cangro CB, Hariharan S, Hricik DE, Kerman RH, Roth D, et al. The evaluation of renal transplantation candidates: Clinical practice guidelines. Am J Transplant 2001;1(Suppl 2):3–95.PubMedGoogle Scholar
  43. 43.
    Maisonneuve P, Agodoa L, Gellert R, Stewart JH, Buccianti G, Lowenfels AB, et al. Cancer in patients on dialysis for end-stage renal disease: An inter­national collaborative study. Lancet 1999;354(9173):93–99.PubMedCrossRefGoogle Scholar
  44. 44.
    Smith RA, Cokkinides V, Brawley OW. Cancer screening in the United States, 2009: a review of ­current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin 2009;59(1):27–41.PubMedCrossRefGoogle Scholar
  45. 45.
    Guide to clinical preventive services, 2008: Recommendations of the U.S. preventive services task force [homepage on the Internet] 2008. September 2008. Available from http://www.ahrq.gov/clinic/pocketgd08/
  46. 46.
    US Preventive Services Task Force. Screening for cervical cancer: Recommendations and rationale. Am J Nurs 2003;103(11):101–102;105–106, 108–109.Google Scholar
  47. 47.
    US Preventive Services Task Force. Screening for breast cancer: recommendations and rationale. Ann Intern Med 2002;137(5 Part 1):344–346.Google Scholar
  48. 48.
    US Preventive Services Task Force. Screening for colorectal cancer: Recommendation and rationale. Ann Intern Med 2002;137(2):129–131.Google Scholar
  49. 49.
    US Preventive Services Task Force. Screening for prostate cancer: Recommendation and rationale. Ann Intern Med 2002;137(11):915–916.Google Scholar
  50. 50.
    Herzog CA, Marwick TH, Pheley AM, White CW, Rao VK, Dick CD. Dobutamine stress echocardiography for the detection of significant coronary artery disease in renal transplant candidates. Am J Kidney Dis 1999;33(6):1080–1090.PubMedCrossRefGoogle Scholar
  51. 51.
    Manske CL, Thomas W, Wang Y, Wilson RF. Screening diabetic transplant candidates for coronary artery disease: Identification of a low risk subgroup. Kidney Int 1993;44(3):617–621.PubMedCrossRefGoogle Scholar
  52. 52.
    Sharma R, Pellerin D, Gaze DC, Gregson H, Streather CP, Collinson PO, et al. Dobutamine stress echocardiography and the resting but not exercise electrocardiograph predict severe coronary artery disease in renal transplant candidates. Nephrol Dial Transplant 2005;20(10):2207–2214.PubMedCrossRefGoogle Scholar
  53. 53.
    Feringa HH, Bax JJ, Schouten O, Poldermans D. Ischemic heart disease in renal transplant candidates: towards noninvasive approaches for preoperative risk stratification. Eur J Echocardiogr 2005;6(5):313–316.PubMedCrossRefGoogle Scholar
  54. 54.
    Manske CL, Wilson RF, Wang Y, Thomas W. Prevalence of, and risk factors for, angiographically determined coronary artery disease in type I-diabetic patients with nephropathy. Arch Intern Med 1992;152(12):2450–2455.PubMedCrossRefGoogle Scholar
  55. 55.
    Manske CL, Wang Y, Rector T, Wilson RF, White CW. Coronary revascularisation in insulin-dependent diabetic patients with chronic renal failure. Lancet 1992;340(8826):998–1002.PubMedCrossRefGoogle Scholar
  56. 56.
    Molina JE, Sutherland DE, Wang Y, Gruessner AC, Bland BJ. Coronary bypass before simultaneous pancreas-kidney transplants for type 1 diabetics in renal failure. World J Surg 2004;28(10):1036–1039.PubMedCrossRefGoogle Scholar
  57. 57.
    Assmann G, Carmena R, Cullen P, Fruchart JC, Jossa F, Lewis B, et al. Coronary heart disease: Reducing the risk: a worldwide view. International Task Force for the Prevention of Coronary Heart Disease. Circulation 1999;100(18):1930–1938.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of UrologyGlickman Urological and Kidney InstituteClevelandUSA

Personalised recommendations