title: Combined en-bloc liver-pancreas transplantation in patients with liver cirrhosis and insulin-dependent type 2 diabetes mellitus.
abstract: We report about our experience with combined en-bloc liver-pancreas transplantation in 14 patients with liver cirrhosis and insulin dependent type 2 diabetes mellitus. Exocrine drainage was achieved by duodeno-duodenostomy. Median posttransplant follow-up is currently 92.5 months. All patients were rendered independent from insulin therapy shortly after transplantation. Levels of glycosylated hemoglobin normalized in all recipients. Mean fasting C-peptide values increased from pretransplant 7.0+/-1.7 ng/mL to 10.5+/-2.9 ng/mL 3 months posttransplantation (P<0.001). One recipient (7.1%) developed recurrent exogenous insulin dependence 7 years after transplantation. Pancreas allograft rejection was confirmed by endoscopic biopsy of donor duodenum mucosa in two patients (14.3%). Calculated 5- and 7-year survival is currently at 64.3% and 64.3%, respectively. Our results indicate that combined en-bloc liver-pancreas transplantation using duodeno-duodenostomy is technically feasible and leads to excellent long-term control of glucose metabolism in patients with liver cirrhosis and insulin-dependent type 2 diabetes.
authors.affiliation: Department of General, Visceral and Vascular Surgery, Friedrich-Schiller-University, Jena, Germany. Arno.Kornberg@med.uni-jena.de
authors.forename: Arno
authors.initials: A
authors.lastname: Kornberg
authors.forename: Bernadett
authors.initials: B
authors.lastname: Küpper
authors.forename: Erik
authors.initials: E
authors.lastname: Bärthel
authors.forename: Andrea
authors.initials: A
authors.lastname: Tannapfel
authors.forename: Ulrich A
authors.initials: UA
authors.lastname: Müller
authors.forename: Katharina
authors.initials: K
authors.lastname: Thrum
authors.forename: Christof
authors.initials: C
authors.lastname: Kloos
authors.forename: Gunter
authors.initials: G
authors.lastname: Wolf
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000601:surgery*; D004386:Duodenum / Q000637:transplantation; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007328:Insulin / Q000097:blood; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation / Q000276:immunology / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000276:immunology / Q000379:methods*
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D006442:Glycated Hemoglobin; D007166:Immunosuppressive Agents; D007328:Insulin