The role of whole organ pancreas transplantation in the treatment of type I diabetes

Milan Kinkhabwala, Alan Wilkinson, Gabriel Danovitch, J. Thomas Rosenthal, Tracey K. Tooley, Anne Sanford, David Imagawa, Steven Rudich, Philip Seu, Ronald W. Busuttil, Christopher R. Shackleton

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

BACKGROUND AND DEMOGRAPHICS: Clinical course was reviewed for 19 whole organ pancreas transplant recipients at UCLA between 11/14/93 and 5/31/95, 18 of which were simultaneous pancreas kidney transplants and 1 of which was an isolated pancreas after kidney transplant. The initial 4 pancreatic grafts were procured by classical warm dissection techniques while the remaining 15 were procured by rapid en bloc technique. Mean recipient age, duration of diabetes, and daily insulin requirements were 38 years, 25 years, and 45 units, respectively. Bladder drainage of exocrine secretions was used primarily in 18 cases and primary enteric drainage in one. RESULTS: All recipients manifested immediate dialysis and insulin independence. Actuarial patient and graft survival were 100% and 89%, respectively, at a mean follow- up of 396 days (range, 150-660 days). Mean maximal serum amylase on the first postoperative day was 366 U/dL. There were no instances of pancreatic graft vascular thrombosis. Three patients experienced pancreatic leaks (16%), 1 of which resulted in graft loss. Six month posttransplant Hgb A1c was within normal range and significantly lower than pretransplantation values (5.1 vs 10.7, P = 0.002). Mean length of initial hospitalization was 15 days, with 100% of patients requiring at least one readmission. Fifty-eight percent of patients experienced rejection episodes. Ninety-one percent of patients responding to a quality of life survey reported improvement in general sense of well-being after transplantation. CONCLUSIONS: It is concluded that high rates of success may be possible with whole organ pancreas transplantation, even in new programs. Rapid en bloc dissection is a safe, expeditious method of pancreas procurement. Successful pancreatic transplantation is associated with freedom from exogenous insulin administration, normalization of glycated hemoglobin, and subjective improvement in quality of life. However, this modality is associated with higher rates of rejection and readmission, and longer duration of hospitalization when compared with isolated kidney transplantation.

Original languageEnglish (US)
Pages (from-to)516-520
Number of pages5
JournalAmerican Journal of Surgery
Volume171
Issue number5
DOIs
StatePublished - May 1996
Externally publishedYes

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Pancreas Transplantation
Organ Transplantation
Type 1 Diabetes Mellitus
Transplants
Pancreas
Insulin
Dissection
Drainage
Hospitalization
Therapeutics
Transplantation
Quality of Life
Kidney
Glycosylated Hemoglobin A
Graft Survival
Amylases
Kidney Transplantation
Blood Vessels
Dialysis
Reference Values

ASJC Scopus subject areas

  • Surgery

Cite this

Kinkhabwala, M., Wilkinson, A., Danovitch, G., Rosenthal, J. T., Tooley, T. K., Sanford, A., ... Shackleton, C. R. (1996). The role of whole organ pancreas transplantation in the treatment of type I diabetes. American Journal of Surgery, 171(5), 516-520. https://doi.org/10.1016/S0002-9610(97)89613-4

The role of whole organ pancreas transplantation in the treatment of type I diabetes. / Kinkhabwala, Milan; Wilkinson, Alan; Danovitch, Gabriel; Rosenthal, J. Thomas; Tooley, Tracey K.; Sanford, Anne; Imagawa, David; Rudich, Steven; Seu, Philip; Busuttil, Ronald W.; Shackleton, Christopher R.

In: American Journal of Surgery, Vol. 171, No. 5, 05.1996, p. 516-520.

Research output: Contribution to journalArticle

Kinkhabwala, M, Wilkinson, A, Danovitch, G, Rosenthal, JT, Tooley, TK, Sanford, A, Imagawa, D, Rudich, S, Seu, P, Busuttil, RW & Shackleton, CR 1996, 'The role of whole organ pancreas transplantation in the treatment of type I diabetes', American Journal of Surgery, vol. 171, no. 5, pp. 516-520. https://doi.org/10.1016/S0002-9610(97)89613-4
Kinkhabwala, Milan ; Wilkinson, Alan ; Danovitch, Gabriel ; Rosenthal, J. Thomas ; Tooley, Tracey K. ; Sanford, Anne ; Imagawa, David ; Rudich, Steven ; Seu, Philip ; Busuttil, Ronald W. ; Shackleton, Christopher R. / The role of whole organ pancreas transplantation in the treatment of type I diabetes. In: American Journal of Surgery. 1996 ; Vol. 171, No. 5. pp. 516-520.
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abstract = "BACKGROUND AND DEMOGRAPHICS: Clinical course was reviewed for 19 whole organ pancreas transplant recipients at UCLA between 11/14/93 and 5/31/95, 18 of which were simultaneous pancreas kidney transplants and 1 of which was an isolated pancreas after kidney transplant. The initial 4 pancreatic grafts were procured by classical warm dissection techniques while the remaining 15 were procured by rapid en bloc technique. Mean recipient age, duration of diabetes, and daily insulin requirements were 38 years, 25 years, and 45 units, respectively. Bladder drainage of exocrine secretions was used primarily in 18 cases and primary enteric drainage in one. RESULTS: All recipients manifested immediate dialysis and insulin independence. Actuarial patient and graft survival were 100{\%} and 89{\%}, respectively, at a mean follow- up of 396 days (range, 150-660 days). Mean maximal serum amylase on the first postoperative day was 366 U/dL. There were no instances of pancreatic graft vascular thrombosis. Three patients experienced pancreatic leaks (16{\%}), 1 of which resulted in graft loss. Six month posttransplant Hgb A1c was within normal range and significantly lower than pretransplantation values (5.1 vs 10.7, P = 0.002). Mean length of initial hospitalization was 15 days, with 100{\%} of patients requiring at least one readmission. Fifty-eight percent of patients experienced rejection episodes. Ninety-one percent of patients responding to a quality of life survey reported improvement in general sense of well-being after transplantation. CONCLUSIONS: It is concluded that high rates of success may be possible with whole organ pancreas transplantation, even in new programs. Rapid en bloc dissection is a safe, expeditious method of pancreas procurement. Successful pancreatic transplantation is associated with freedom from exogenous insulin administration, normalization of glycated hemoglobin, and subjective improvement in quality of life. However, this modality is associated with higher rates of rejection and readmission, and longer duration of hospitalization when compared with isolated kidney transplantation.",
author = "Milan Kinkhabwala and Alan Wilkinson and Gabriel Danovitch and Rosenthal, {J. Thomas} and Tooley, {Tracey K.} and Anne Sanford and David Imagawa and Steven Rudich and Philip Seu and Busuttil, {Ronald W.} and Shackleton, {Christopher R.}",
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AU - Kinkhabwala, Milan

AU - Wilkinson, Alan

AU - Danovitch, Gabriel

AU - Rosenthal, J. Thomas

AU - Tooley, Tracey K.

AU - Sanford, Anne

AU - Imagawa, David

AU - Rudich, Steven

AU - Seu, Philip

AU - Busuttil, Ronald W.

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N2 - BACKGROUND AND DEMOGRAPHICS: Clinical course was reviewed for 19 whole organ pancreas transplant recipients at UCLA between 11/14/93 and 5/31/95, 18 of which were simultaneous pancreas kidney transplants and 1 of which was an isolated pancreas after kidney transplant. The initial 4 pancreatic grafts were procured by classical warm dissection techniques while the remaining 15 were procured by rapid en bloc technique. Mean recipient age, duration of diabetes, and daily insulin requirements were 38 years, 25 years, and 45 units, respectively. Bladder drainage of exocrine secretions was used primarily in 18 cases and primary enteric drainage in one. RESULTS: All recipients manifested immediate dialysis and insulin independence. Actuarial patient and graft survival were 100% and 89%, respectively, at a mean follow- up of 396 days (range, 150-660 days). Mean maximal serum amylase on the first postoperative day was 366 U/dL. There were no instances of pancreatic graft vascular thrombosis. Three patients experienced pancreatic leaks (16%), 1 of which resulted in graft loss. Six month posttransplant Hgb A1c was within normal range and significantly lower than pretransplantation values (5.1 vs 10.7, P = 0.002). Mean length of initial hospitalization was 15 days, with 100% of patients requiring at least one readmission. Fifty-eight percent of patients experienced rejection episodes. Ninety-one percent of patients responding to a quality of life survey reported improvement in general sense of well-being after transplantation. CONCLUSIONS: It is concluded that high rates of success may be possible with whole organ pancreas transplantation, even in new programs. Rapid en bloc dissection is a safe, expeditious method of pancreas procurement. Successful pancreatic transplantation is associated with freedom from exogenous insulin administration, normalization of glycated hemoglobin, and subjective improvement in quality of life. However, this modality is associated with higher rates of rejection and readmission, and longer duration of hospitalization when compared with isolated kidney transplantation.

AB - BACKGROUND AND DEMOGRAPHICS: Clinical course was reviewed for 19 whole organ pancreas transplant recipients at UCLA between 11/14/93 and 5/31/95, 18 of which were simultaneous pancreas kidney transplants and 1 of which was an isolated pancreas after kidney transplant. The initial 4 pancreatic grafts were procured by classical warm dissection techniques while the remaining 15 were procured by rapid en bloc technique. Mean recipient age, duration of diabetes, and daily insulin requirements were 38 years, 25 years, and 45 units, respectively. Bladder drainage of exocrine secretions was used primarily in 18 cases and primary enteric drainage in one. RESULTS: All recipients manifested immediate dialysis and insulin independence. Actuarial patient and graft survival were 100% and 89%, respectively, at a mean follow- up of 396 days (range, 150-660 days). Mean maximal serum amylase on the first postoperative day was 366 U/dL. There were no instances of pancreatic graft vascular thrombosis. Three patients experienced pancreatic leaks (16%), 1 of which resulted in graft loss. Six month posttransplant Hgb A1c was within normal range and significantly lower than pretransplantation values (5.1 vs 10.7, P = 0.002). Mean length of initial hospitalization was 15 days, with 100% of patients requiring at least one readmission. Fifty-eight percent of patients experienced rejection episodes. Ninety-one percent of patients responding to a quality of life survey reported improvement in general sense of well-being after transplantation. CONCLUSIONS: It is concluded that high rates of success may be possible with whole organ pancreas transplantation, even in new programs. Rapid en bloc dissection is a safe, expeditious method of pancreas procurement. Successful pancreatic transplantation is associated with freedom from exogenous insulin administration, normalization of glycated hemoglobin, and subjective improvement in quality of life. However, this modality is associated with higher rates of rejection and readmission, and longer duration of hospitalization when compared with isolated kidney transplantation.

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