Pancreatic Pathology Online

Pancreas Transplantation  

Dr Sampurna Roy MD          

 

Indications:  Type 1 diabetes with end-stage renal disease ;  Chronic pancreatitis. 

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In most cases, pancreas transplantation is performed in the setting of  type 1 diabetes with end-stage renal disease.

Total pancreatectomy to treat chronic pancreatitis is associated with severe diabetic control problems in 15% to 75% of patients, causing up to 50% of deaths late postoperatively.

According to one study islet autotransplants at the time of total pancreatectomy in patients who  had not had previous operations on the body and tail of the pancreas were associated with a high islet yield , and >70% of the recipients achieved complete insulin independence.

The series showed that pancreas allotransplants can be performed without transplant-related mortality and, when tacrolimus-based immunosuppression is used, with  1-year pancreas graft survival rates >75%.

In contrast to a simultaneous islet autotransplant, a pancreas allotransplant has the disadvantage of requiring lifelong immunosuppression, but the advantage of not only curing endocrine but also exocrine insufficiency.

Both transplant options,  if successful, improve the recipient's quality of life.

Contraindications : Absolute contraindications to transplantation of any type include active malignancy or infection.

Three main types of pancreas transplantation:

1) simultaneous pancreas-kidney transplant, in which the pancreas and kidney are transplanted from the same deceased donor;

2) pancreas-after-kidney transplant, in which a cadaveric, or deceased, donor pancreas transplant is performed after a previous, and different, living or deceased donor kidney transplant; and

3) pancreas transplant alone for the patient with type 1 diabetes who usually has severe, frequent hypoglycemia, but adequate kidney  function.

Pancreas transplantation is a successful and effective procedure resulting in  tight glucose control.

Due to the postoperative morbidity and the need for immunosuppression pancreas transplantation should be considered at the time of kidney transplantation.

Transplantation of the pancreas alone may be indicated in type 1 diabetics who suffer from life threatening hypoglycaemia, not caused by external factors.

The patients have unacceptably poor metabolic control and quality of life despite optimal medical treatment.

The prerequisite is adequate renal function.

Recently, islet transplantation became a less invasive alternative to pancreas transplantation.

A variety of factors have led to significant improvements in graft and patient survival, including advances in surgical techniques, immuno- suppression, graft preservation techniques, methods of diagnosis and treatment of rejection, and management of common post- transplant complications.

Complications of pancreas transplant :

Immediate complications that can occur with all types of pancreas transplant include rejection, thrombosis, pancreatitis, and infection.

Exocrine pancreatic duct leaks and allograft pancreatitis are usually due to technical failures, preservation injury, or infection, leading to fluid collections, pseudocysts, or abscesses surrounding the pancreatic graft.

The technical failure rate refers to graft failure attributed to an immediate complication of surgery.

The technical failure rate is lowest with simultaneous pancreas-kidney transplant.

Thrombosis is the most common cited cause of graft failure.

Vascular thrombosis can also accompany rejection and pancreatitis.

Pancreas transplantation has been associated with improvement in diabetic retinopathy, nephropathy, neuropathy and vasculopathy, but has the associated morbidity of major surgery.

 

Further reading:

Therapy of diabetes mellitus. Pancreas transplantation, islet transplantation, stem cell and gene therapy.

Expanding the indications of pancreas transplantation alone.

Current indications for pancreas or islet transplant.

Pancreas transplantation: indications and consequences.

Transplant options for patients undergoing total pancreatectomy for chronic pancreatitis.

A new indication for pancreas transplantation: high grade pancreatic dysplasia.

Organ transplantation in endocrinology. Islet cells and pancreas].

Pancreatic autotransplantation in chronic pancreatitis.

Pancreas transplantation: the histologic morphology of graft loss and clinical correlations.

Pancreas rejection. Significance of histopathologic findings with implications for classification of rejection.

Pancreas transplant pathology. A morphologic, immunohistochemical, and electron microscopic comparison of allogeneic grafts with rejection, syngeneic grafts, and chronic pancreatitis. 

 

 

 

Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)


 

 

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