A pancreas transplant is an organ transplant Organ transplantation is the moving of an organ from one body to another, or from a donor site on the patient's own body, for the purpose of replacing the recipient's damaged or absent organ. The emerging field of Regenerative medicine is allowing scientists and engineers to create organs to be re-grown from the patient's own cells Organs and/or that involves implanting a healthy pancreas The pancreas is a gland organ in the digestive and endocrine system of vertebrates. It is both an endocrine gland producing several important hormones, including insulin, glucagon, and somatostatin, as well as an exocrine gland, secreting pancreatic juice containing digestive enzymes that pass to the small intestine. These enzymes help to further (one that can produce insulin) into a person who usually has diabetes Diabetes mellitus, often simply referred to as diabetes—is a condition in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria , polydipsia (increased thirst) and polyphagia (. Because the pancreas is a vital organ, performing functions necessary in the digestion process, the recipient's native pancreas is left in place, and the donated pancreas is attached in a different location. In the event of rejection of the new pancreas which would quickly cause life-threatening diabetes, the recipient could not survive without the native pancreas still in place. The healthy pancreas comes from a donor who has just died or it may be a partial pancreas from a living donor. [1] At present, pancreas transplants are usually performed in persons with insulin-dependent diabetes, whom can develop severe complications. Patients with pancreatic cancer Pancreatic cancer is a malignant neoplasm of the pancreas. By the end of 2010 in the United States is estimated that about 43,140 individuals will be diagnosed with this condition and 36,800 will die from the disease. The prognosis is relatively poor but has improved; the three-year survival rate is now about thirty percent, but less than 5 are not eligible for valuable pancreatic transplantations, since the condition has a very high mortality rate and the disease, being highly malignant, could and probably would soon return.

Contents

Types

There are three main types of pancreas transplantation:

Indications

In most cases, pancreas transplantation is performed on individuals with type 1 diabetes Diabetes mellitus, often simply referred to as diabetes—is a condition in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria , polydipsia (increased thirst) and polyphagia ( with end-stage renal disease Causes of nephropathy include administration of analgesics, xanthine oxidase deficiency, and long-term exposure to lead or its salts. Chronic conditions that can produce nephropathy include systemic lupus erythematosus, diabetes mellitus and high blood pressure , which lead to diabetic nephropathy and hypertensive nephropathy, respectively. The majority of pancreas transplantations (>90%) are simultaneous pancreas-kidney transplantions.[2]

Preservation until implantation

Standard practice is to replace the donor's blood in the pancreatic tissue with an ice-cold organ storage solution, such as UW (Viaspan) or HTK until the allograft pancreatic tissue is implanted.

Complications

Complications immediately after surgery include thrombosis Thrombosis is the formation of a blood clot (thrombus) inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body uses platelets and fibrin to form a blood clot to prevent blood loss. If the clotting is too severe and the clot breaks free, the traveling clot is now know as an, pancreatitis Pancreatitis is inflammation of the pancreas that can occur in two very different forms. Acute pancreatitis is sudden while chronic pancreatitis "is characterized by recurring or persistent abdominal pain with or without steatorrhea or diabetes mellitus.", infection An infection is the detrimental colonization of a host organism by a foreign species. In an infection, the infecting organism seeks to utilize the host's resources to multiply, usually at the expense of the host. The infecting organism, or pathogen, interferes with the normal functioning of the host and can lead to chronic wounds, gangrene, loss, bleeding and rejection Transplant rejection occurs when a transplanted organ or tissue is not accepted by the body of the transplant recipient. This is explained by the concept that the immune system of the recipient attacks the transplanted organ or tissue. This is expected to happen, because the immune system's purpose is to distinguish foreign material within the. Rejection may occur immediately or at any time during the patient's life. This is because the transplanted pancreas comes form another organism, thus the recipient's immune system will consider it as an aggression and try to combat it. Organ rejection is a serious condition and ought to be treated immediately. In order to prevent it, patients must take a regimen of immunosuppressive drugs Immunosuppressive drugs or immunosuppressive agents are drugs that inhibit or prevent activity of the immune system. They are used in immunosuppressive therapy to:. Drugs are taken in combination consisting normally of cyclosporine, azathioprine Azathioprine is used in organ transplantation and autoimmune disease. Some of the autoimmune diseases are rheumatoid arthritis, pemphigus, Inflammatory Bowel Disease , multiple sclerosis, autoimmune hepatitis and restrictive lung disease and corticosteroids Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiologic systems such as stress response, immune response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte levels, and behavior. But as episodes of rejection may reoccur throughout a patient's life, the exact choices and dosages of immunosuppressants may have to be modified over time. Sometimes tacrolimus Tacrolimus is an immunosuppressive drug whose main use is after allogeneic organ transplant to reduce the activity of the patient's immune system and so lower the risk of organ rejection. It reduces interleukin-2 (IL-2) production by T-cells. It is also used in a topical preparation in the treatment of severe atopic dermatitis (eczema), severe is given instead of cyclosporine and mycophenolate mofetil instead of azathioprine.

Prognosis

The prognosis after pancreas transplantation is very good. Over the recent years, long-term success has improved and risks have decreased. One year after transplantation more than 95% of all patients are still alive and 80-85% of all pancreases are still functional. After transplantation patients need lifelong immunosuppression Immunosuppression involves an act that reduces the activation or efficacy of the immune system. Some portions of the immune system itself have immuno-suppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse reaction to treatment of other conditions. Deliberately induced immunosuppression is generally. Immunosuppression increases the risk for a number of different kinds of infection[3] and cancer.

History

The first pancreas transplantation was performed in 1966 by the team of Dr. Kelly, Dr. Lillehei, Dr.Merkel, Dr.Idezuki Y, & Dr. Goetz, three years after the first kidney transplantation.[4] A pancreas along with kidney and duodenum was transplanted into a 28-year-old woman and her blood sugar levels decreased immediately after transplantation, but eventually she died three months later from pulmonary embolism. In 1979 the first living-related partial pancreas transplantation was done.

References

  1. ^ Type 1 cures - pancreas transplants
  2. ^ 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 (4): 433–55. doi A digital object identifier is a character string used to uniquely identify an electronic document or other object. Metadata about the object is stored in association with the DOI name and this metadata may include a location, such as a URL, where the object can be found. The DOI for a document is permanent, whereas its location and other metadata:10.1111/j.1399-0012.2005.00378.x. PMID A PMID is a unique number assigned to each PubMed citation of life sciences and biomedical scientific journal articles. The related Pubmed Central archive may additionally assign a separate number, a PMCID (PubMed Central Identifier), normally written with a PMC prefix 16008587.
  3. ^ Fishman JA, Rubin RH (1998). "Infection in organ-transplant recipients". N Engl J Med 338 (24): 1741–51. doi A digital object identifier is a character string used to uniquely identify an electronic document or other object. Metadata about the object is stored in association with the DOI name and this metadata may include a location, such as a URL, where the object can be found. The DOI for a document is permanent, whereas its location and other metadata:10.1056/NEJM199806113382407. PMID A PMID is a unique number assigned to each PubMed citation of life sciences and biomedical scientific journal articles. The related Pubmed Central archive may additionally assign a separate number, a PMCID (PubMed Central Identifier), normally written with a PMC prefix 9624195. Full text
  4. ^ Kelly WD, Lillehei RC, Merkel FK, Idezuki Y, Goetz FC (1967). "Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy". Surgery 61 (6): 827–37. PMID A PMID is a unique number assigned to each PubMed citation of life sciences and biomedical scientific journal articles. The related Pubmed Central archive may additionally assign a separate number, a PMCID (PubMed Central Identifier), normally written with a PMC prefix 5338113.

External links

Organ transplantation An organ transplant is the moving of an organ from one body to another, or from a donor site on the patient's own body, for the purpose of replacing the recipient's damaged or absent organ. The emerging field of Regenerative medicine is allowing scientists to engineer organs to be re-grown from the patient's own cells
Types Autotransplantation · Allotransplantation Allotransplantation is the transplantation of cells, tissues, or organs, sourced from a genetically non-identical member of the same species as the recipient.. The transplant is called an allograft or allogeneic transplant or homograft. Most human tissue and organ transplants are allografts · Xenotransplantation Xenotransplantation is the transplantation of living cells, tissues or organs from one species to another, such as from pigs to humans (see medical grafting). Such cells, tissues or organs are called xenografts or xenotransplants. In contrast, the term allotransplantation refers to a same-species transplant. Human xenotransplantation offers a
Organs and tissues Bone Bone grafting is a surgical procedure that replaces missing bone with material from the patient's own body, an artificial, synthetic, or natural substitute. Bone grafting is used to repair bone fractures that are extremely complex, pose a significant health risk to the patient, or fail to heal properly · Bone marrow Hematopoietic stem cell transplantation is the transplantation of blood stem cells derived from the bone marrow (in this case known as bone marrow transplantation) or blood. Stem cell transplantation is a medical procedure in the fields of hematology and oncology, most often performed for people with diseases of the blood, bone marrow, or certain · Corneal Corneal transplantation, also known as corneal grafting or penetrating keratoplasty, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue which has been removed from a recently deceased individual having no known diseases which might affect the viability of the donated tissue. The cornea is the clear · Face People with faces disfigured by trauma, burns, disease, or birth defects might benefit from the procedure · Hand The operation is carried out in the following order: bone fixation, tendon repair, artery repair, nerve repair, then vein repair. The operation typically lasts 8 to 12 hours. By comparison, a typical heart transplant operation lasts 6 to 8 hours · Head · Heart Heart transplantation, or cardiac transplantation, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease. The most common procedure is to take a working heart from a recently deceased organ donor and implant it into the patient. The patient's own heart may either be removed ( · Heart-lung A heart-lung transplant is a procedure carried out to replace both heart and lungs in a single operation. Due to a shortage of suitable donors, it is a rare procedure; only about a hundred such transplants are performed each year in the USA · Kidney Kidney transplantation or renal transplantation is the organ transplant of a kidney into a patient with end-stage renal disease. Kidney transplantation is typically classified as deceased-donor or living-donor transplantation depending on the source of the donor organ. Living-donor renal transplants are further characterized as genetically related · Liver Liver transplantation or hepatic transplantation is the replacement of a diseased liver with a healthy liver allograft. The most commonly used technique is orthotopic transplantation, in which the native liver is removed and the donor organ is placed in the same anatomic location as the original liver. Liver transplantation nowadays is a well · Lung Lung transplantation is a surgical procedure in which a patient's diseased lungs are partially or totally replaced by lungs which come from a donor. While lung transplants carry certain associated risks, they can also extend life expectancy and enhance the quality of life for end-stage pulmonary patients · Pancreas · Penis · Skin Skin grafting is a type of medical grafting involving the transplantation of skin. The transplanted tissue is called a skin graft · Spleen · Uterus
Related topics Biomedical tissue Biomedical tissue is biological tissue used for organ transplantation and medical research, particularly cancer research · Edmonton protocol The Edmonton Protocol is a method of implantation of pancreatic islets for the treatment of type 1 diabetes mellitus, specifically "brittle" type 1 diabetics prone to hypoglycemic unawareness. The protocol is named for the islet transplantation group at the University of Alberta in the Canadian city of Edmonton, where the protocol was · Eye bank Eye banks retrieve and store eyes for cornea transplants and research. US eye banks provide tissue for about 46,000 cornea transplants a year to treat conditions such as keratoconus and cornea scarring. The cornea is not the only part of the eye that can currently undergo transplantation. The sclera can also be used to repair recipient eyes in · Graft-versus-host disease Graft-versus-host disease is a common complication of allogeneic bone marrow transplantation in which functional immune cells in the transplanted marrow recognize the recipient as "foreign" and mount an immunologic attack. It can also take place in a blood transfusion under certain circumstances · Immunosuppressive drugs Immunosuppressive drugs or immunosuppressive agents are drugs that inhibit or prevent activity of the immune system. They are used in immunosuppressive therapy to: · Islet cell transplantation Islet transplantation is the transplantation of isolated islets from a donor pancreas and into another person. It is an experimental treatment for type 1 diabetes mellitus. Once transplanted, the islets begin to produce insulin, actively regulating the level of glucose in the blood · Living donor liver transplantation Liver transplantation or hepatic transplantation is the replacement of a diseased liver with a healthy liver allograft. The most commonly used technique is orthotopic transplantation, in which the native liver is removed and the donor organ is placed in the same anatomic location as the original liver. Liver transplantation nowadays is a well · Lung allocation score The lung allocation score is a numerical value used by the United Network for Organ Sharing (UNOS) to assign relative priority for distributing donated lungs for transplantation within the United States. The lung allocation score takes into account various measures of a patient's health in order to direct donated organs towards the patients who · Machine perfusion Machine perfusion is a technique used in organ transplantation as a means of preserving the organs which are to be transplanted. To some degree, it emulates natural perfusion. So far it has mainly been used in kidney transplantation. It is an alternative to cold storage (CS). Its clinical and cost-effectiveness are still subject to research · Medical grafting In medicine, the word grafting can refer to a surgical procedure to transplant tissue. The implanted tissue must have a blood supply, either surgically created by anastomosis of blood vessels or by growth of blood vessels from the new vascular bed. The word grafting can also refer to the placement of a natural or artificial conduit to carry blood · Non-heart beating donation · Organ donation Organ donation is the removal of the tissues of the human body from a person who has recently died, or from a living donor, for the purpose of transplanting. Organs and tissues are removed in procedures similar to surgery. People of all ages may be organ and tissue donors · Organ harvesting · Organ trade Organ trade is the trade involving human organs for transplantation. It is a business driven by the simple market calculus of supply and demand. General belief is that there is a worldwide shortage of organs available for transplantion. However, considering the predictions of economic theory and analysis of empirical data, the shortages are · Post-transplant lymphoproliferative disorder · Total body irradiation Total body irradiation is a form of radiotherapy used primarily as part of the preparative regimen for haematopoietic stem cell (or bone marrow) transplantation. As the name implies, TBI involves irradiation of the entire body, though in modern practice the lungs are often partially shielded to lower the risk of radiation-induced lung injury · Transplant rejection · Transplantation medicine
Organizations Halachic Organ Donor Society · Human Tissue Authority · National Marrow Donor Program · United Network for Organ Sharing · DKMS Americas
Countries Organ transplantation in the People's Republic of China · Organ transplantation in Israel · Organ transplantation in Japan · Organ theft in Kosovo · Organ transplantation in different countries · Gurgaon kidney scandal
People Christiaan Barnard · Michael Woodruff · Alexis Carrel · Norman Shumway · Jean-Michel Dubernard · List of notable organ transplant donors and recipients
Digestive system surgical and other procedures (ICD-9-CM V3 42-54)
Digestive tract
Upper GI tract
SGs/Esophagus Sialography · Esophagectomy · Impedance-pH monitoring · Esophageal pH monitoring · Esophageal motility study
Stomach Gastrostomy (Percutaneous endoscopic gastrostomy) · Gastrectomy (Billroth I, Billroth II, Roux-en-Y) · Bariatric surgery (Gastric bypass surgery, Adjustable gastric band, Sleeve gastrectomy, Vertical banded gastroplasty surgery) · Gastroenterostomy · Hill repair · Nissen fundoplication · Gastropexy · Pyloromyotomy
Imaging

Endoscopy: Esophagogastroduodenoscopy

Upper gastrointestinal series
Lower GI tract
Small bowel Bariatric surgery (Duodenal switch, Jejunoileal bypass) · Jejunostomy · Ileostomy · Partial ileal bypass surgery
Large bowel Colectomy · Colostomy · Appendicectomy · Hartmann's operation
Rectum Lower anterior resection · Abdominoperineal resection
Anus Anal sphincterotomy · Lateral internal sphincterotomy
Imaging

Endoscopy: Colonoscopy (Virtual) · Proctoscopy · Sigmoidoscopy · Enteroscopy · Capsule endoscopy

Transrectal ultrasonography · Enteroclysis · Small bowel follow-through · Abdominal ultrasonography · Lower gastrointestinal series
Stool tests Fecal pH test · Stool guaiac test · Fecal fat test
Accessory
Liver Hepatectomy · Liver transplantation · Artificial extracorporeal liver support (Liver dialysis, Bioartificial liver devices)
Gallbladder, bile duct Cholangiography (Endoscopic retrograde cholangiopancreatography, Percutaneous transhepatic cholangiography, Magnetic resonance cholangiopancreatography) · Cholecystectomy · Cholecystography · Cholescintigraphy · Hepatoportoenterostomy
Pancreas Pancreatectomy · Pancreaticoduodenectomy · Pancreas transplantation · Puestow procedure · Frey's procedure
Abdominopelvic
Peritoneum Paracentesis · Intraperitoneal injection
Hernia Herniorrhaphy · Macewen's operation
Other Laparotomy

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Categories: Surgery | Organ transplants

 

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