The pancreas transplantation is a form of pancreatic beta cell replacement, diabetes patients can help to normoglycemia again.
(See also Overview transplant.) The pancreas transplantation is a form of pancreatic beta cell replacement, diabetes patients can help to normoglycemia again. Since the receiver eintauscht the risks of insulin injection against the risks of immunosuppression, a pancreas transplant is mostly limited type 1 and renal failure, the so eligible for a kidney transplant in patients with diabetes. More than 90% of pancreatic transplants involve the transplantation of a kidney. and the repeated failure to control glycemia with standard therapy and episodes of unrecognized hypoglycemia apply at many clinics as eligibility criteria for a pancreas transplant. Relative contraindications are aged> 55 years and a significant atherosclerosis of the cardiovascular system, following myocardial infarction, coronary bypass surgery, percutaneous coronary or positive stress test; all factors lead to a drastic increase in the perioperative risk. Options Simultaneous pancreas-kidney (SPN) Transplantation pancreatic after kidney (PNN) Transplantation sole pancreas transplantation The advantages of the simultaneous pancreas-kidney are that the receiver is exposed only once to a high dose Induktionsimmunsuppression and the newly transplanted kidney potentially from unwanted effects is protected hyperglycaemia. In addition, the kidney is more prone to rejection than the pancreas, in which a rejection is not easy to establish. The advantages of a pancreas kidney transplant are the ability to optimize the HLA compatibility and timing of renal transplantation with a living donor. In patients who do not suffer from terminal diabetic kidney disease, but probably because of other severe diabetic complications and unstable blood sugar, isolated pancreas transplants are performed. Pancreatic donors Donors are usually between 10 and 55 years old and died shortly before transplantation. Their histories are free of glucose intolerance and alcohol abuse. In the simultaneous pancreas-kidney stem both from the same donor. There are the same restrictions on the kidney donation. There have also been segmental transplants from living donors performed (<1%). A wider application is thereby limited, however, that this method poses a considerable risk for the donor (eg. B. splenic infarction, abscesses, pancreatitis, drainage of pancreatic secretion and pseudocyst formation, secondary diabetes). Procedure Following treatment of the donor with anticoagulants is perfused the abdominal artery with a cold storage solution. Then, the pancreas in situ is cooled with an ice-containing saline, and liver (for transplantation into a different recipient) and the second portion of the duodenum, which contains the father ampoule is removed as a whole. The iliac artery is also removed. The pancreas of the donor is implanted intraperitoneally in the recipient lateral lower abdomen. In a simultaneous pancreas-kidney transplant the pancreas is implanted in the lower right quadrant of the abdomen and the kidney in the lower left quadrant. The native pancreas remains at the original location. The iliac artery of the donor is used for reconstruction at the back, to reconstruct the splenic artery and superior mesenteric artery of the pancreas graft. This technique results in an artery that has a connection to the recipient's blood vessels. The final anastomoses are produced between the iliac artery of the donor and one of the iliac artery of the recipient as well as between the portal vein of the donor and the iliac artery of the recipient. The systemic endocrine secretions drainage causes hyperinsulinemia. Although anastomosis of pancreatic venous system of the donor is a side branch of the portal vein of a challenge and the benefits are not clearly documented, it is still carried out in some cases to produce a physiological situation. The Duodenumsegment is sutured to the bladder dome or stapled to the small intestine to allow the drainage of exocrine secretions. The therapeutic strategies for immunosuppressants vary, but usually consist of immunosuppressive Ig, a calcineurin inhibitor, a purine synthesis inhibitor and corticosteroids, which may be tapered slowly over the course of 12 months (see table: immunosuppressants for the treatment of transplant rejection). Complications rejection Despite adequate immunosuppression occurs in 40-60% of patients to acute rejection, affecting primarily non-endocrine, but the exocrine factors. Compared to an isolated kidney transplantation simultaneous pancreas-kidney transplant carries a higher risk of rejection. In addition, the rejection episodes tend to occur later and more often repeated and to be resistant to corticosteroids. The symptoms are non-specific (see table: manifestations of pancreatic transplant rejection by category). After simultaneous pancreas-kidney transplant and pancreas-after-kidney transplant a kidney rejection is almost always associated with a pancreatic rejection. The best evidence of pancreatic rejection is an elevated serum creatinine levels. After an isolated pancreas transplantation rejection response in patients is ruled out with a Harndrainage due to a stable amylase in the urine; a decrease in the concentration indicates a certain graft dysfunction, but is not a specific sign of rejection. Therefore, early detection is difficult. The diagnosis is confirmed by ultrasound-guided percutaneous or cystoscopic biopsy. Early complications affecting 10-15% of patients. Manifestations of pancreatic allograft rejection after rejection Category Category manifestations hyper acute pancreatic necrosis, fever, hyperglycemia Speeds pancreatitis, hyperglycemia, increased amylase and lipase acute treatment Same as accelerated chronic hyperglycemia, slightly elevated amylase and lipase Other complications first complications arise in 10-15% of patients and manifest as wound infection and dehiscence, gross haematuria, intra-abdominal leakage of urine, Refluxpankreatitis, recurrent urinary tract infections, small bowel obstruction, abdominal abscess and graft thrombosis. Late complications associated with a sodium carbonate (NaHCO3 -) - loss by drainage of the pancreas in the bladder, which leads to lack of volume and metabolic acidosis non-anion. Hyperinsulinemia does not seem to adversely affect the glucose or lipid metabolism. Prognosis The 1-year survival rates in patients> 90% grafts: 78% It is unclear whether the survival of transplant recipients is higher than that of patients without transplantation; However, the primary benefit of transplantation lies in the liberation of insulin therapy and in the stabilization or slight improvement of many diabetic complications (eg. as nephropathy, neuropathy). Graft survival is Simultaneous pancreas-kidney transplants pancreatic after kidney transplantation sole pancreas transplantation: 76% The rate of immunological graft loss in pancreatic after kidney transplants and pancreas transplants alone is higher, possibly because a reliable in such a transplanted pancreas monitor for rejection is missing; however, the rejection can be monitored after simultaneous pancreas-kidney transplant rejection with established indicators.