Living-donor pancreas and small-bowel transplantation
Abstract Background: In contrast to renal and liver transplantation, only a limited number of pancreas and intestinal live-donor transplants have so far been reported. Patients: The vast majority of live segmental pancreas transplants have been performed at the University of Minnesota. From 1979 to...
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| Format: |
E-Artikel |
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| Sprache: |
Englisch |
| Erschienen: |
1999 |
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| Umfang: |
6 |
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| Reproduktion: |
Springer Online Journal Archives 1860-2002 |
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| Übergeordnetes Werk: |
in: Langenbeck's archives of surgery - 1948, 384(1999) vom: Juni, Seite 544-549 |
| Übergeordnetes Werk: |
volume:384 ; year:1999 ; month:06 ; pages:544-549 ; extent:6 |
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NLEJ204689279 |
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| 520 | |a Abstract Background: In contrast to renal and liver transplantation, only a limited number of pancreas and intestinal live-donor transplants have so far been reported. Patients: The vast majority of live segmental pancreas transplants have been performed at the University of Minnesota. From 1979 to 1993, a total of 78 solitary pancreas transplants – 28 after kidney and 49 pancreas transplants alone – were performed and, from 1994 to August 1999, 27 simultaneous pancreas/kidney transplants. For the first intestinal transplant, a segment of ileum from the mother was used in Boston in 1964. In 1970, 170 cm of jejuno-ileum from a human leukocyte antigen (HLA)- identical sister was removed and transplanted in New York. In 1988, an intestinal transplant from a haplotype-identical sister was performed at Kiel University, Germany. In the 1990s, a few more intestinal transplants from live donors were reported to the registry. Results: No death occurred among pancreas or intestinal donors. Altogether, seven pancreas donors required splenectomy and several donors required drainage of abscesses or fluid collections. Three of the 78 pancreas donors and at least two of the 27 pancreas/kidney donors required insulin post-donation. Twenty-seven of the solitary segmental pancreas transplants failed for technical reasons. Graft survival of technically successful pancreas transplants was 68% after 1 year and 38% after 10 years. Patient and renal allograft survival of combined kidney/pancreas transplants after 1 year was 100%, while 1-year pancreas survival was 84%. The first recipient of a live-donor intestinal transplant died only 12 h after surgery. The second case lived for 79 days and was able to eat for 6 weeks. A patient transplanted in 1988 lived for 4 years mainly on oral nutrition. Many of the live-donor intestinal transplants carried out in the 1990s became long-term survivors. Conclusion: Pancreas and small-bowel transplantation using organs from live donors is possible in experienced centers, with no donor mortality and excellent survival rates for recipients and grafts. Since abnormal glucose tolerance post-donation cannot be excluded with certainty and since, for the time being, there is no pancreas or small-bowel shortage in Europe, live donation of these organs should be restricted mainly to highly sensitized patients with a cross-match-negative relative or HLA-identical donor-intestinal recipient combinations. | ||
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(DE-627)NLEJ204689279 DE-627 ger DE-627 rakwb eng Living-donor pancreas and small-bowel transplantation 1999 6 nicht spezifiziert zzz rdacontent nicht spezifiziert z rdamedia nicht spezifiziert zu rdacarrier Abstract Background: In contrast to renal and liver transplantation, only a limited number of pancreas and intestinal live-donor transplants have so far been reported. Patients: The vast majority of live segmental pancreas transplants have been performed at the University of Minnesota. From 1979 to 1993, a total of 78 solitary pancreas transplants – 28 after kidney and 49 pancreas transplants alone – were performed and, from 1994 to August 1999, 27 simultaneous pancreas/kidney transplants. For the first intestinal transplant, a segment of ileum from the mother was used in Boston in 1964. In 1970, 170 cm of jejuno-ileum from a human leukocyte antigen (HLA)- identical sister was removed and transplanted in New York. In 1988, an intestinal transplant from a haplotype-identical sister was performed at Kiel University, Germany. In the 1990s, a few more intestinal transplants from live donors were reported to the registry. Results: No death occurred among pancreas or intestinal donors. Altogether, seven pancreas donors required splenectomy and several donors required drainage of abscesses or fluid collections. Three of the 78 pancreas donors and at least two of the 27 pancreas/kidney donors required insulin post-donation. Twenty-seven of the solitary segmental pancreas transplants failed for technical reasons. Graft survival of technically successful pancreas transplants was 68% after 1 year and 38% after 10 years. Patient and renal allograft survival of combined kidney/pancreas transplants after 1 year was 100%, while 1-year pancreas survival was 84%. The first recipient of a live-donor intestinal transplant died only 12 h after surgery. The second case lived for 79 days and was able to eat for 6 weeks. A patient transplanted in 1988 lived for 4 years mainly on oral nutrition. Many of the live-donor intestinal transplants carried out in the 1990s became long-term survivors. Conclusion: Pancreas and small-bowel transplantation using organs from live donors is possible in experienced centers, with no donor mortality and excellent survival rates for recipients and grafts. Since abnormal glucose tolerance post-donation cannot be excluded with certainty and since, for the time being, there is no pancreas or small-bowel shortage in Europe, live donation of these organs should be restricted mainly to highly sensitized patients with a cross-match-negative relative or HLA-identical donor-intestinal recipient combinations. Springer Online Journal Archives 1860-2002 Margreiter, R. oth in Langenbeck's archives of surgery 1948 384(1999) vom: Juni, Seite 544-549 (DE-627)NLEJ188993363 (DE-600)1459390-7 1435-2451 nnns volume:384 year:1999 month:06 pages:544-549 extent:6 http://dx.doi.org/10.1007/s004230050241 GBV_USEFLAG_U ZDB-1-SOJ GBV_NL_ARTICLE AR 384 1999 6 544-549 6 |
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(DE-627)NLEJ204689279 DE-627 ger DE-627 rakwb eng Living-donor pancreas and small-bowel transplantation 1999 6 nicht spezifiziert zzz rdacontent nicht spezifiziert z rdamedia nicht spezifiziert zu rdacarrier Abstract Background: In contrast to renal and liver transplantation, only a limited number of pancreas and intestinal live-donor transplants have so far been reported. Patients: The vast majority of live segmental pancreas transplants have been performed at the University of Minnesota. From 1979 to 1993, a total of 78 solitary pancreas transplants – 28 after kidney and 49 pancreas transplants alone – were performed and, from 1994 to August 1999, 27 simultaneous pancreas/kidney transplants. For the first intestinal transplant, a segment of ileum from the mother was used in Boston in 1964. In 1970, 170 cm of jejuno-ileum from a human leukocyte antigen (HLA)- identical sister was removed and transplanted in New York. In 1988, an intestinal transplant from a haplotype-identical sister was performed at Kiel University, Germany. In the 1990s, a few more intestinal transplants from live donors were reported to the registry. Results: No death occurred among pancreas or intestinal donors. Altogether, seven pancreas donors required splenectomy and several donors required drainage of abscesses or fluid collections. Three of the 78 pancreas donors and at least two of the 27 pancreas/kidney donors required insulin post-donation. Twenty-seven of the solitary segmental pancreas transplants failed for technical reasons. Graft survival of technically successful pancreas transplants was 68% after 1 year and 38% after 10 years. Patient and renal allograft survival of combined kidney/pancreas transplants after 1 year was 100%, while 1-year pancreas survival was 84%. The first recipient of a live-donor intestinal transplant died only 12 h after surgery. The second case lived for 79 days and was able to eat for 6 weeks. A patient transplanted in 1988 lived for 4 years mainly on oral nutrition. Many of the live-donor intestinal transplants carried out in the 1990s became long-term survivors. Conclusion: Pancreas and small-bowel transplantation using organs from live donors is possible in experienced centers, with no donor mortality and excellent survival rates for recipients and grafts. Since abnormal glucose tolerance post-donation cannot be excluded with certainty and since, for the time being, there is no pancreas or small-bowel shortage in Europe, live donation of these organs should be restricted mainly to highly sensitized patients with a cross-match-negative relative or HLA-identical donor-intestinal recipient combinations. Springer Online Journal Archives 1860-2002 Margreiter, R. oth in Langenbeck's archives of surgery 1948 384(1999) vom: Juni, Seite 544-549 (DE-627)NLEJ188993363 (DE-600)1459390-7 1435-2451 nnns volume:384 year:1999 month:06 pages:544-549 extent:6 http://dx.doi.org/10.1007/s004230050241 GBV_USEFLAG_U ZDB-1-SOJ GBV_NL_ARTICLE AR 384 1999 6 544-549 6 |
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(DE-627)NLEJ204689279 DE-627 ger DE-627 rakwb eng Living-donor pancreas and small-bowel transplantation 1999 6 nicht spezifiziert zzz rdacontent nicht spezifiziert z rdamedia nicht spezifiziert zu rdacarrier Abstract Background: In contrast to renal and liver transplantation, only a limited number of pancreas and intestinal live-donor transplants have so far been reported. Patients: The vast majority of live segmental pancreas transplants have been performed at the University of Minnesota. From 1979 to 1993, a total of 78 solitary pancreas transplants – 28 after kidney and 49 pancreas transplants alone – were performed and, from 1994 to August 1999, 27 simultaneous pancreas/kidney transplants. For the first intestinal transplant, a segment of ileum from the mother was used in Boston in 1964. In 1970, 170 cm of jejuno-ileum from a human leukocyte antigen (HLA)- identical sister was removed and transplanted in New York. In 1988, an intestinal transplant from a haplotype-identical sister was performed at Kiel University, Germany. In the 1990s, a few more intestinal transplants from live donors were reported to the registry. Results: No death occurred among pancreas or intestinal donors. Altogether, seven pancreas donors required splenectomy and several donors required drainage of abscesses or fluid collections. Three of the 78 pancreas donors and at least two of the 27 pancreas/kidney donors required insulin post-donation. Twenty-seven of the solitary segmental pancreas transplants failed for technical reasons. Graft survival of technically successful pancreas transplants was 68% after 1 year and 38% after 10 years. Patient and renal allograft survival of combined kidney/pancreas transplants after 1 year was 100%, while 1-year pancreas survival was 84%. The first recipient of a live-donor intestinal transplant died only 12 h after surgery. The second case lived for 79 days and was able to eat for 6 weeks. A patient transplanted in 1988 lived for 4 years mainly on oral nutrition. Many of the live-donor intestinal transplants carried out in the 1990s became long-term survivors. Conclusion: Pancreas and small-bowel transplantation using organs from live donors is possible in experienced centers, with no donor mortality and excellent survival rates for recipients and grafts. Since abnormal glucose tolerance post-donation cannot be excluded with certainty and since, for the time being, there is no pancreas or small-bowel shortage in Europe, live donation of these organs should be restricted mainly to highly sensitized patients with a cross-match-negative relative or HLA-identical donor-intestinal recipient combinations. Springer Online Journal Archives 1860-2002 Margreiter, R. oth in Langenbeck's archives of surgery 1948 384(1999) vom: Juni, Seite 544-549 (DE-627)NLEJ188993363 (DE-600)1459390-7 1435-2451 nnns volume:384 year:1999 month:06 pages:544-549 extent:6 http://dx.doi.org/10.1007/s004230050241 GBV_USEFLAG_U ZDB-1-SOJ GBV_NL_ARTICLE AR 384 1999 6 544-549 6 |
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(DE-627)NLEJ204689279 DE-627 ger DE-627 rakwb eng Living-donor pancreas and small-bowel transplantation 1999 6 nicht spezifiziert zzz rdacontent nicht spezifiziert z rdamedia nicht spezifiziert zu rdacarrier Abstract Background: In contrast to renal and liver transplantation, only a limited number of pancreas and intestinal live-donor transplants have so far been reported. Patients: The vast majority of live segmental pancreas transplants have been performed at the University of Minnesota. From 1979 to 1993, a total of 78 solitary pancreas transplants – 28 after kidney and 49 pancreas transplants alone – were performed and, from 1994 to August 1999, 27 simultaneous pancreas/kidney transplants. For the first intestinal transplant, a segment of ileum from the mother was used in Boston in 1964. In 1970, 170 cm of jejuno-ileum from a human leukocyte antigen (HLA)- identical sister was removed and transplanted in New York. In 1988, an intestinal transplant from a haplotype-identical sister was performed at Kiel University, Germany. In the 1990s, a few more intestinal transplants from live donors were reported to the registry. Results: No death occurred among pancreas or intestinal donors. Altogether, seven pancreas donors required splenectomy and several donors required drainage of abscesses or fluid collections. Three of the 78 pancreas donors and at least two of the 27 pancreas/kidney donors required insulin post-donation. Twenty-seven of the solitary segmental pancreas transplants failed for technical reasons. Graft survival of technically successful pancreas transplants was 68% after 1 year and 38% after 10 years. Patient and renal allograft survival of combined kidney/pancreas transplants after 1 year was 100%, while 1-year pancreas survival was 84%. The first recipient of a live-donor intestinal transplant died only 12 h after surgery. The second case lived for 79 days and was able to eat for 6 weeks. A patient transplanted in 1988 lived for 4 years mainly on oral nutrition. Many of the live-donor intestinal transplants carried out in the 1990s became long-term survivors. Conclusion: Pancreas and small-bowel transplantation using organs from live donors is possible in experienced centers, with no donor mortality and excellent survival rates for recipients and grafts. Since abnormal glucose tolerance post-donation cannot be excluded with certainty and since, for the time being, there is no pancreas or small-bowel shortage in Europe, live donation of these organs should be restricted mainly to highly sensitized patients with a cross-match-negative relative or HLA-identical donor-intestinal recipient combinations. Springer Online Journal Archives 1860-2002 Margreiter, R. oth in Langenbeck's archives of surgery 1948 384(1999) vom: Juni, Seite 544-549 (DE-627)NLEJ188993363 (DE-600)1459390-7 1435-2451 nnns volume:384 year:1999 month:06 pages:544-549 extent:6 http://dx.doi.org/10.1007/s004230050241 GBV_USEFLAG_U ZDB-1-SOJ GBV_NL_ARTICLE AR 384 1999 6 544-549 6 |
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(DE-627)NLEJ204689279 DE-627 ger DE-627 rakwb eng Living-donor pancreas and small-bowel transplantation 1999 6 nicht spezifiziert zzz rdacontent nicht spezifiziert z rdamedia nicht spezifiziert zu rdacarrier Abstract Background: In contrast to renal and liver transplantation, only a limited number of pancreas and intestinal live-donor transplants have so far been reported. Patients: The vast majority of live segmental pancreas transplants have been performed at the University of Minnesota. From 1979 to 1993, a total of 78 solitary pancreas transplants – 28 after kidney and 49 pancreas transplants alone – were performed and, from 1994 to August 1999, 27 simultaneous pancreas/kidney transplants. For the first intestinal transplant, a segment of ileum from the mother was used in Boston in 1964. In 1970, 170 cm of jejuno-ileum from a human leukocyte antigen (HLA)- identical sister was removed and transplanted in New York. In 1988, an intestinal transplant from a haplotype-identical sister was performed at Kiel University, Germany. In the 1990s, a few more intestinal transplants from live donors were reported to the registry. Results: No death occurred among pancreas or intestinal donors. Altogether, seven pancreas donors required splenectomy and several donors required drainage of abscesses or fluid collections. Three of the 78 pancreas donors and at least two of the 27 pancreas/kidney donors required insulin post-donation. Twenty-seven of the solitary segmental pancreas transplants failed for technical reasons. Graft survival of technically successful pancreas transplants was 68% after 1 year and 38% after 10 years. Patient and renal allograft survival of combined kidney/pancreas transplants after 1 year was 100%, while 1-year pancreas survival was 84%. The first recipient of a live-donor intestinal transplant died only 12 h after surgery. The second case lived for 79 days and was able to eat for 6 weeks. A patient transplanted in 1988 lived for 4 years mainly on oral nutrition. Many of the live-donor intestinal transplants carried out in the 1990s became long-term survivors. Conclusion: Pancreas and small-bowel transplantation using organs from live donors is possible in experienced centers, with no donor mortality and excellent survival rates for recipients and grafts. Since abnormal glucose tolerance post-donation cannot be excluded with certainty and since, for the time being, there is no pancreas or small-bowel shortage in Europe, live donation of these organs should be restricted mainly to highly sensitized patients with a cross-match-negative relative or HLA-identical donor-intestinal recipient combinations. Springer Online Journal Archives 1860-2002 Margreiter, R. oth in Langenbeck's archives of surgery 1948 384(1999) vom: Juni, Seite 544-549 (DE-627)NLEJ188993363 (DE-600)1459390-7 1435-2451 nnns volume:384 year:1999 month:06 pages:544-549 extent:6 http://dx.doi.org/10.1007/s004230050241 GBV_USEFLAG_U ZDB-1-SOJ GBV_NL_ARTICLE AR 384 1999 6 544-549 6 |
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Patients: The vast majority of live segmental pancreas transplants have been performed at the University of Minnesota. From 1979 to 1993, a total of 78 solitary pancreas transplants – 28 after kidney and 49 pancreas transplants alone – were performed and, from 1994 to August 1999, 27 simultaneous pancreas/kidney transplants. For the first intestinal transplant, a segment of ileum from the mother was used in Boston in 1964. In 1970, 170 cm of jejuno-ileum from a human leukocyte antigen (HLA)- identical sister was removed and transplanted in New York. In 1988, an intestinal transplant from a haplotype-identical sister was performed at Kiel University, Germany. In the 1990s, a few more intestinal transplants from live donors were reported to the registry. Results: No death occurred among pancreas or intestinal donors. Altogether, seven pancreas donors required splenectomy and several donors required drainage of abscesses or fluid collections. Three of the 78 pancreas donors and at least two of the 27 pancreas/kidney donors required insulin post-donation. Twenty-seven of the solitary segmental pancreas transplants failed for technical reasons. Graft survival of technically successful pancreas transplants was 68% after 1 year and 38% after 10 years. Patient and renal allograft survival of combined kidney/pancreas transplants after 1 year was 100%, while 1-year pancreas survival was 84%. The first recipient of a live-donor intestinal transplant died only 12 h after surgery. The second case lived for 79 days and was able to eat for 6 weeks. A patient transplanted in 1988 lived for 4 years mainly on oral nutrition. Many of the live-donor intestinal transplants carried out in the 1990s became long-term survivors. Conclusion: Pancreas and small-bowel transplantation using organs from live donors is possible in experienced centers, with no donor mortality and excellent survival rates for recipients and grafts. Since abnormal glucose tolerance post-donation cannot be excluded with certainty and since, for the time being, there is no pancreas or small-bowel shortage in Europe, live donation of these organs should be restricted mainly to highly sensitized patients with a cross-match-negative relative or HLA-identical donor-intestinal recipient combinations.</subfield></datafield><datafield tag="533" ind1=" " ind2=" "><subfield code="f">Springer Online Journal Archives 1860-2002</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Margreiter, R.</subfield><subfield code="4">oth</subfield></datafield><datafield tag="773" ind1="0" ind2="8"><subfield code="i">in</subfield><subfield code="t">Langenbeck's archives of surgery</subfield><subfield code="d">1948</subfield><subfield code="g">384(1999) vom: Juni, Seite 544-549</subfield><subfield code="w">(DE-627)NLEJ188993363</subfield><subfield code="w">(DE-600)1459390-7</subfield><subfield code="x">1435-2451</subfield><subfield code="7">nnns</subfield></datafield><datafield tag="773" ind1="1" ind2="8"><subfield code="g">volume:384</subfield><subfield code="g">year:1999</subfield><subfield code="g">month:06</subfield><subfield code="g">pages:544-549</subfield><subfield code="g">extent:6</subfield></datafield><datafield tag="856" ind1="4" ind2="0"><subfield code="u">http://dx.doi.org/10.1007/s004230050241</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_USEFLAG_U</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">ZDB-1-SOJ</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_NL_ARTICLE</subfield></datafield><datafield tag="951" ind1=" " ind2=" "><subfield code="a">AR</subfield></datafield><datafield tag="952" ind1=" " ind2=" "><subfield code="d">384</subfield><subfield code="j">1999</subfield><subfield code="c">6</subfield><subfield code="h">544-549</subfield><subfield code="g">6</subfield></datafield></record></collection>
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Abstract Background: In contrast to renal and liver transplantation, only a limited number of pancreas and intestinal live-donor transplants have so far been reported. Patients: The vast majority of live segmental pancreas transplants have been performed at the University of Minnesota. From 1979 to 1993, a total of 78 solitary pancreas transplants – 28 after kidney and 49 pancreas transplants alone – were performed and, from 1994 to August 1999, 27 simultaneous pancreas/kidney transplants. For the first intestinal transplant, a segment of ileum from the mother was used in Boston in 1964. In 1970, 170 cm of jejuno-ileum from a human leukocyte antigen (HLA)- identical sister was removed and transplanted in New York. In 1988, an intestinal transplant from a haplotype-identical sister was performed at Kiel University, Germany. In the 1990s, a few more intestinal transplants from live donors were reported to the registry. Results: No death occurred among pancreas or intestinal donors. Altogether, seven pancreas donors required splenectomy and several donors required drainage of abscesses or fluid collections. Three of the 78 pancreas donors and at least two of the 27 pancreas/kidney donors required insulin post-donation. Twenty-seven of the solitary segmental pancreas transplants failed for technical reasons. Graft survival of technically successful pancreas transplants was 68% after 1 year and 38% after 10 years. Patient and renal allograft survival of combined kidney/pancreas transplants after 1 year was 100%, while 1-year pancreas survival was 84%. The first recipient of a live-donor intestinal transplant died only 12 h after surgery. The second case lived for 79 days and was able to eat for 6 weeks. A patient transplanted in 1988 lived for 4 years mainly on oral nutrition. Many of the live-donor intestinal transplants carried out in the 1990s became long-term survivors. Conclusion: Pancreas and small-bowel transplantation using organs from live donors is possible in experienced centers, with no donor mortality and excellent survival rates for recipients and grafts. Since abnormal glucose tolerance post-donation cannot be excluded with certainty and since, for the time being, there is no pancreas or small-bowel shortage in Europe, live donation of these organs should be restricted mainly to highly sensitized patients with a cross-match-negative relative or HLA-identical donor-intestinal recipient combinations. |
| abstractGer |
Abstract Background: In contrast to renal and liver transplantation, only a limited number of pancreas and intestinal live-donor transplants have so far been reported. Patients: The vast majority of live segmental pancreas transplants have been performed at the University of Minnesota. From 1979 to 1993, a total of 78 solitary pancreas transplants – 28 after kidney and 49 pancreas transplants alone – were performed and, from 1994 to August 1999, 27 simultaneous pancreas/kidney transplants. For the first intestinal transplant, a segment of ileum from the mother was used in Boston in 1964. In 1970, 170 cm of jejuno-ileum from a human leukocyte antigen (HLA)- identical sister was removed and transplanted in New York. In 1988, an intestinal transplant from a haplotype-identical sister was performed at Kiel University, Germany. In the 1990s, a few more intestinal transplants from live donors were reported to the registry. Results: No death occurred among pancreas or intestinal donors. Altogether, seven pancreas donors required splenectomy and several donors required drainage of abscesses or fluid collections. Three of the 78 pancreas donors and at least two of the 27 pancreas/kidney donors required insulin post-donation. Twenty-seven of the solitary segmental pancreas transplants failed for technical reasons. Graft survival of technically successful pancreas transplants was 68% after 1 year and 38% after 10 years. Patient and renal allograft survival of combined kidney/pancreas transplants after 1 year was 100%, while 1-year pancreas survival was 84%. The first recipient of a live-donor intestinal transplant died only 12 h after surgery. The second case lived for 79 days and was able to eat for 6 weeks. A patient transplanted in 1988 lived for 4 years mainly on oral nutrition. Many of the live-donor intestinal transplants carried out in the 1990s became long-term survivors. Conclusion: Pancreas and small-bowel transplantation using organs from live donors is possible in experienced centers, with no donor mortality and excellent survival rates for recipients and grafts. Since abnormal glucose tolerance post-donation cannot be excluded with certainty and since, for the time being, there is no pancreas or small-bowel shortage in Europe, live donation of these organs should be restricted mainly to highly sensitized patients with a cross-match-negative relative or HLA-identical donor-intestinal recipient combinations. |
| abstract_unstemmed |
Abstract Background: In contrast to renal and liver transplantation, only a limited number of pancreas and intestinal live-donor transplants have so far been reported. Patients: The vast majority of live segmental pancreas transplants have been performed at the University of Minnesota. From 1979 to 1993, a total of 78 solitary pancreas transplants – 28 after kidney and 49 pancreas transplants alone – were performed and, from 1994 to August 1999, 27 simultaneous pancreas/kidney transplants. For the first intestinal transplant, a segment of ileum from the mother was used in Boston in 1964. In 1970, 170 cm of jejuno-ileum from a human leukocyte antigen (HLA)- identical sister was removed and transplanted in New York. In 1988, an intestinal transplant from a haplotype-identical sister was performed at Kiel University, Germany. In the 1990s, a few more intestinal transplants from live donors were reported to the registry. Results: No death occurred among pancreas or intestinal donors. Altogether, seven pancreas donors required splenectomy and several donors required drainage of abscesses or fluid collections. Three of the 78 pancreas donors and at least two of the 27 pancreas/kidney donors required insulin post-donation. Twenty-seven of the solitary segmental pancreas transplants failed for technical reasons. Graft survival of technically successful pancreas transplants was 68% after 1 year and 38% after 10 years. Patient and renal allograft survival of combined kidney/pancreas transplants after 1 year was 100%, while 1-year pancreas survival was 84%. The first recipient of a live-donor intestinal transplant died only 12 h after surgery. The second case lived for 79 days and was able to eat for 6 weeks. A patient transplanted in 1988 lived for 4 years mainly on oral nutrition. Many of the live-donor intestinal transplants carried out in the 1990s became long-term survivors. Conclusion: Pancreas and small-bowel transplantation using organs from live donors is possible in experienced centers, with no donor mortality and excellent survival rates for recipients and grafts. Since abnormal glucose tolerance post-donation cannot be excluded with certainty and since, for the time being, there is no pancreas or small-bowel shortage in Europe, live donation of these organs should be restricted mainly to highly sensitized patients with a cross-match-negative relative or HLA-identical donor-intestinal recipient combinations. |
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Living-donor pancreas and small-bowel transplantation |
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Margreiter, R. |
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