Rescue therapy with tacrolimus in simultaneous pancreas/kidney transplantation

Tacrolimus has been effective both in primary and rescue therapy following steroid and OKT3-resistant acute rejection in liver and kidney transplantation. Due to the effects of tacrolimus on glucose metabolism, there has been concern about its use in simultaneous pancreas/kidney transplantation. We report on the results of six patients (three female, three male, age 35.2 ± 7.3 years) converted from cyclosporin A to tacrolimus following simultaneous pancreas/kidney transplantation in steroid-resistant acute rejection. Tacrolimus was induced 2.8 ± 1.7 months (range 1–4.8 months) after transplantation; follow-up was 3–18 months. Following conversion, creatinine levels declined in all patients [3.5 ± 1.2 mg/dl before conversion, 3.0 ± 1.9 mg/dl (n = 6) at three months, 1.4 ± 0.1 mg/dl at 1 year (n = 3)]. Before conversion, fasting blood glucose levels averaged 154 ± 33 mg/dl, with three patients receiving insulin. Three months later no patient required insulin, the mean glucose level being 107 ± 23 mg/dl (n = 6); at 1 year it was 92 ± 9 mg/dl (n = 3). One patient lost his pancreatic graft after 4 months due to a mycotic aneurysm. We conclude that conversion to tacrolimus is a safe and effective treatment in cases of steroid-resistant rejections following pancreas/kidney transplantation.     

Somatostatinoma: a case report and review of the literature

Somatostatinomas are rare endocrine tumors that were first described in 1977. In addition to the present case report, there have been 31 cases reported in the literature. We have reviewed the literature to integrate the symptoms, physical findings, diagnostic tests, treatment, and length of survival of these patients. Although the symptoms that occurred in the majority of cases were those that are seen in most patients with intra-abdominal neoplasms, symptoms relating to the presence of excess circulating somatostatin--diabetes, maldigestion, and cholelithiasis--were frequently seen. Physical findings and the results of diagnostic tests were usually nonspecific. The majority of the patients underwent radical surgical procedures (Whipple procedure or pancreatic resection). The pancreas was the most frequent site of involvement (21/31 cases), but primaries in the duodenum, ampulla of Vater, cystic duct, and jejunum have been described as well. Metastases were most frequently seen in the liver and lymph nodes. Chemotherapeutic agents were administered to 10 patients, usually as adjuvant therapy, and appear to be useful in treating recurrent and metastatic disease. The one-year survival of these patients is 48%, which is better than that for patients with carcinoma of the pancreas or biliary tree. Therefore, it is important that the diagnosis of somatostinoma be made so that the patient may be treated accordingly and followed by serial somatostatin levels for evidence of metastasis or recurrent disease.     

Are Criteria for Islet and Pancreas Donors Sufficiently Different to Minimize Competition?

Islet and pancreas transplantation may compete for a limited number of organs. We analyzed records from the national Swiss transplant registry during a 4-year period to investigate the proportion of donors that are suitable for islet and pancreas transplantation. Suitability for pancreas transplantation was mainly defined as: age 10-45 years; weight pancreas, islet transplantation, and both procedures, respectively. Giving priority to pancreas transplantation and accepting the absence of one selection criterion, 90 (28%) pancreas and 100 (31%) islet donors were identified. We conclude that with current allocation policies prioritizing pancreas transplantation, pancreas and islet transplantation may coexist with little competition.     

Morphological and functional changes induced by dalargin in the pancreas in the normal state and in experimental pancreatitis

Central Research Laboratory, Andizhan Medical Institute. Department of Pathomorphology, N. V. Sklifosovskii Moscow Emergency Aid Research Institute. (Presented by Academician of the Academy of Medical Sciences of the USSR D. S. Sarkisov.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 105, No. 4, pp. 445–447, April, 1988.     

Risk Factors and Impact of Delayed Graft Function after Pancreas Transplants

Delayed graft function (DGF) occurs after many pancreas transplants (PTx), but is poorly characterized. We studied its incidence, course, and impact in a series of 531 pancreas transplants. Between January 1997 and September 2002, we performed 531 technically successful primary PTx. Of these 531 recipients, 176 (33%) had DGF, defined by their need for exogenous insulin at the time of hospital discharge. The incidence of DGF was roughly equivalent in the three transplant categories: SPK (36%), PAK (32%), and PTA (31%) (p = NS). By 3 months posttransplant, only 19 (3.5%) of all recipients remained on insulin. Only three recipients (0.56%) did not achieve insulin independence. The mean donor age of recipients with DGF was 35.1 years vs. 28.8 years without DGF (p = 0.003). By multivariate analysis, the most significant risk factor for DGF was donor age > 45 years (RR = 4.3, p = 0.0001). For SPK recipients with DGF, graft survival was 87% at 1 year and 82% at 3 years posttransplant; without DGF, 94% at 1 year and 87% at 3 years (p = 0.07). For PAK and PTA recipients, no difference was noted. Acute rejection rates were somewhat higher in recipients with DGF, but this did not reach statistical significance.     

Role of cholinergic structures at different levels in rapid adaptation of the pancreas to food quality in ontogeny

Department of Normal Physiology, Central Asiatic Medical Pediatric Institute, Tashkent. (Presented by Academician of the Academy of Medical Sciences of the USSR K. V. Sudakov.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 110, No. 11, pp. 457–458, 1990.     

The Impact of Donor Obesity on Outcomes after Cadaver Pancreas Transplants

We examined the impact of donor obesity on surgical complications and graft function after pancreas transplants. From January 1994 through December 2001, we performed 711 cadaver pancreas transplants. We analyzed outcomes for three groups based on donor body mass index (BMI): <25 kg/m2 (n=434), 25-30 (n=196), and >30 (n=81). Donor characteristics were similar between the three groups except for donor cause of death. Cerebrovascular deaths were more common in the BMI >30 group (p=0.002), while trauma deaths were more common in the BMI <25 group (p=0.02). In the BMI >30 group, surgical complications, most notably surgical infections and thrombosis, were significantly more common; in addition, technical failure rates were higher and short-term graft survival was inferior. The incidence of technical failure was 9.7% in the BMI <25 group, 16.3% in the BMI 25-30 group, and 21.0% in the BMI >30 group (p=0.04). However, when we looked at only technically successful transplants, we found minimal differences in the three groups with regard to graft survival at 1 and 3 years posttransplant. Donor obesity increased the incidence of surgical complications in our pancreas recipients, but did not affect initial graft function posttransplant. Technically successful transplants using obese donors results in good graft function at 1 and 3 years posttransplant.     

Small Cell Undifferentiated Carcinoma of the Pancreas

Small cell undifferentiated carcinoma of the pancreas is a rare neoplasm: Only 12 cases have previously been documented. This paper describes the clinical evolution, immunohistochemical profile, and ultrastructural features of a case occurring in a 37-year-old woman.     

Transplantation in patients with diabetic nephropathy: Outcome of combined pancreas and kidney transplantation compared with kidney transplantation only

Abstract. Detailed results of 12 combined pancreas and kidney transplantations (Comb) were compared with those of two matched diabetic controls per patient-one living donor kidney recipient (LD) and one cadaveric donor kidney recipient (CD)-who, though eligible for pancreas transplantation also, preferred kidney transplantation only. Mean follow-up was 22,23, and 21 months in the three groups. There was no mortality in the LD group, but two CD and one Comb patient died from cardiovascular disease. Two kidneys were lost in both the Comb and the LD group, compared to five in the CD group. Ten major vascular events occurred and three of them were lethal. The only LD case was one below-knee amputation; the other nine were equally distributed in the Comb and CD groups. The time spent in the hospital was shorter for the LD group. Thus, in the short run, LDs confer the best results, whereas in the long term the better metabolic control in the Combs may prove favorable.     

Insulinreserve und Morphologie des Pankreasschwanzes nach Pankreaskopfresektion bei unterschiedlichen Methoden der Versorgung

Zusammenfassung Die Insulinreserve und Morphologie des Restpankreas wurde an 4 unterschiedlichen Modifikationen der Pankreasversorgung nach Pankreaskopfresektion vergleichend untersucht. Neben einer Kontrollgruppe wurde der Pankreasschwanz durch Gangligatur, Occlusion des Ganges mit Prolamin, mit einer Pancreatojejunostomie (Y-Roux) sowie freier Drainage des Hauptganges in die Bauchhöhle versorgt. Präoperativ und 12 Wochen postoperativ wurde ein intravenöser Glucosetoleranztest (i.v. GTI) durchgeführt. Die histologische Aufarbeitung des Restpankreas zeigte, daß nach Occlusion mit Prolamin die Sklerose des exokrinen Parenchyms vorherrschend war, nach Gangligatur hingegen die Atrophie des exokrinen Gewebes. Bei Tieren mit freier Gangdrainage fand sich ein Mischbild aus Atrophie sowie deutlichen Zeichen der Sklerose. Histologisch war das Drüsengewebe bei den Y-Roux-Tieren nahezu unverändert, lediglich im Anastomosenbereich waren sklerosierende Umbauvorgänge nachweisbar. Für alle Versuchsgruppen ließ sich ein enger Zusammenhang der erhobenen pathologisch-histologischen Befunde am Restpankreas mit der Sekretion von Insulin sowie dem Verhalten des Blutzuckers bei dem i.v. GTT herstellen. Bei den Tieren mit der Occlusion des Hauptganges oder der freien Drainage zeigte sich eine pathologische Glucosetoleranz. Bei der Gangligatur war eine normale Glucosetoleranz mit erhaltener Insulinsekretion nachweisbar.

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Insulin reserve and morphology of the pancreatic tail after pancreas head resection by different surgical methods of treatment

Summary Four modifications of dealing surgically with the remaining pancreas after resection of the pancreatic head were compared to each other in dogs. Insulin response and corresponding blood sugar levels were controlled, the remaining pancreas was examined histologically. The obstruction of the pancreatic ducts by prolamin showed mainly sclerosis of the exocrine tissue whereas the duct ligation was followed by atrophy. The free intraperitoneal draining of the duct system showed both alterations, the pancreatojejunostomy did hardly impair the exocrine pancreas. According to the grade of sclerosis of the exocrine tissue, the insulin response was delayed followed by a pathologic glucose tolerance. This was shown particularly for the obstruction of the ducts by prolamin.