Combined 'en bloc' liver and pancreas transplantation in patients with liver disease and type 1 diabetes mellitus.
Liver disease alters the glucose metabolism and may cause diabetes, but this condition is potentially reversible with liver transplantation (LTx). Type 1 diabetes mellitus may be coincidentally present in a LTx candidate and immunosuppressive drugs will aggravate diabetes and make its management more difficult for posttransplant. In addition, diabetes negatively influences outcome after LTx. Therefore, the question arises as to why not transplanting the pancreas in addition to the liver in selected patients suffering from both liver disease and Type 1 diabetes. We report two cases of en bloc combined liver and pancreatic transplantation, a technique originally described a decade ago in the treatment of upper abdominal malignancies but rarely used for the treatment of combined liver disease and Type 1 diabetes. Both recipients are currently liver disease-free and insulin-free more than 2 and 4 years posttransplant, respectively. Surgical, medical and immunological aspects of combined liver-pancreas transplantation are discussed in the light of the existing relevant literature.
Department of Abdominal Transplant Surgery-Transplant Coordination, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium. Jacques.Pirenne@uz.kuleuven.ac.be
Jacques
J
Pirenne
Koen
K
Deloose
Willy
W
Coosemans
Raymond
R
Aerts
Frank
F
Van Gelder
Dirk
D
Kuypers
Bart
B
Maes
Chris
C
Verslype
Paul
P
Yap
Werner
W
Van Steenbergen
Tania
T
Roskams
Chantal
C
Mathieu
Johan
J
Fevery
Frederik
F
Nevens
D000328:Adult; D002761:Cholangitis / Q000150:complications / Q000601:surgery*; D002779:Cholestasis / Q000150:complications / Q000601:surgery*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000379:methods*; D016896:Treatment Outcome