title: Pancreas transplantation: lessons learned from a decade of experience at Wake Forest Baptist Medical Center.
abstract: This article reviews the outcome of pancreas transplantations in diabetic recipients according to risk factors, surgical techniques, and immunosuppression management that evolved over the course of a decade at Wake Forest Baptist Medical Center. A randomized trial of alemtuzumab versus rabbit anti-thymocyte globulin (rATG) induction in simultaneous kidney-pancreas transplantation (SKPT) at our institution demonstrated lower rates of acute rejection and infection in the alemtuzumab group. Consequently, alemtuzumab induction has been used exclusively in all pancreas transplantations since February 2009. Early steroid elimination has been feasible in the majority of patients. Extensive experience with surveillance pancreas biopsies in solitary pancreas transplantation (SPT) is described. Surveillance pancreas biopsy-directed immunosuppression has contributed to equivalent long-term pancreas graft survival rates in SKPT and SPT recipients at our center, in contrast to recent registry reports of persistently higher rates of immunologic pancreas graft loss in SPT. Furthermore, the impact of donor and recipient selection on outcomes is explored. Excellent results have been achieved with older (extended) donors and recipients, in recipients of organs from donation after cardiac death donors managed with extracorporeal support, and in African-American patients. Type 2 diabetics with detectable C-peptide levels have been transplanted successfully with outcomes comparable to those of insulinopenic diabetics. Our experiences are discussed in the light of findings reported in the literature.
authors: Department of General Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA. jerogers@wfubmc.edu
authors: Jeffrey
authors: J
authors: Rogers
authors: Alan C
authors: AC
authors: Farney
authors: Samer
authors: S
authors: Al-Geizawi
authors: Samy S
authors: SS
authors: Iskandar
authors: William
authors: W
authors: Doares
authors: Michael D
authors: MD
authors: Gautreaux
authors: Lois
authors: L
authors: Hart
authors: Scott
authors: S
authors: Kaczmorski
authors: Amber
authors: A
authors: Reeves-Daniel
authors: Stephanie
authors: S
authors: Winfrey
authors: Mythili
authors: M
authors: Ghanta
authors: Patricia L
authors: PL
authors: Adams
authors: Robert J
authors: RJ
authors: Stratta
mesh_terms: D002096:C-Peptide / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation / Q000276:immunology / Q000379:methods; D010179:Pancreas / Q000473:pathology; D016035:Pancreas Transplantation / Q000276:immunology / Q000379:methods; D016032:Randomized Controlled Trials as Topic
chemical_list: D002096:C-Peptide