title: Successful solitary pancreas transplantation with portal-enteric drainage following unsuccessful islet cell transplantation.
abstract: BACKGROUND
  There are no data regarding the outcome of solitary pancreas transplantation (SPT) with portal venous drainage (PVD) following unsuccessful islet transplantation (ITx) after multiple islet injections into the portal vein. We herein describe the outcome of three SPTs with PVD performed after failed ITx.
  
  
  METHODS
  Between October 2002 and December 2003, three SPTs with PVD were performed following unsuccessful ITx with multiple intraportal islet injections (mean 2.3 injections: range 2 to 3 injections) in two women and one man, aged 26, 49, and 60 years. Panel reactive antibody titer was 0% in all recipients. Immunosuppression was based on induction with either basiliximab (n = 2) or thymoglobulin (n = 1); maintenance therapy included steroids, mycophenolate mofetil, and tacrolimus. During the recipient operation, the absence of venous hypertension was established by direct measurement of portal pressure, before making the final decision to drain the pancreas into the portal vein.
  
  
  RESULTS
  Portal pressures were 16 cm H2O, 14 cm H2O, and 13 cm H2O. Pancreas grafts were reperfused after a period of cold preservation of 638, 695, and 835 minutes, respectively. All grafts showed immediate endocrine function, maintaining their recipients insulin-independent for longest follow-ups of 8, 21, and 23 months, respectively. One recipient developed a nonocclusive venous thrombus that resolved with intravenous heparin infusion.
  
  
  CONCLUSIONS
  Our experience showed that unsuccessful ITx with multiple intraportal injections does not necessarily preclude the possibility of subsequent successful SPT with PVD. Further experience is needed to define contraindications and possible complications of SPT with PVD following ITx.
authors.affiliation: University of Pisa, Pisa, Italy.
authors.forename: U
authors.initials: U
authors.lastname: Boggi
authors.forename: F
authors.initials: F
authors.lastname: Vistoli
authors.forename: S
authors.initials: S
authors.lastname: Signori
authors.forename: M
authors.initials: M
authors.lastname: Del Chiaro
authors.forename: A
authors.initials: A
authors.lastname: Campatelli
authors.forename: M
authors.initials: M
authors.lastname: Massa
authors.forename: F
authors.initials: F
authors.lastname: Sgambelluri
authors.forename: A
authors.initials: A
authors.lastname: Coppelli
authors.forename: P
authors.initials: P
authors.lastname: Marchetti
authors.forename: S
authors.initials: S
authors.lastname: Del Prato
authors.forename: F
authors.initials: F
authors.lastname: Mosca
mesh_terms: D001794:Blood Pressure; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D004322:Drainage; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects* / Q000379:methods; D007518:Isoantibodies / Q000627:therapeutic use; D016035:Pancreas Transplantation / Q000379:methods / Q000502:physiology*; D011168:Portal System; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D007518:Isoantibodies