Pancreas Transplantation: Lessons Learned from a Decade of Experience at Wake Forest Baptist Medical Center

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Abstract
The Review of Diabetic Studies,2011,8,1,17-27.
Published:May 2011
Type:Review Article
Authors:
Author(s) affiliations:

Jeffrey Rogers1, Alan C. Farney1, Samer Al-Geizawi1, Samy S. Iskandar2, William Doares3, Michael D. Gautreaux1, Lois Hart1, Scott Kaczmorski3, Amber Reeves-Daniel4, Stephanie Winfrey1, Mythili Ghanta4, Patricia L. Adams4, and Robert J. Stratta1

1Department of General Surgery, 2Department of Pathology, 3Department of Pharmacy, 4Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.

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.