Related Experiment Videos
Rejection of isolated pancreatic allografts in patients with with diabetes
Abstract:
Four patients with diabetes mellitus of juvenile onset but without uremia have been treated with segmental transplantation of the body and tail of pancreas. The indications were hyperlabile diabetes or progressive loss of vision. The grafts were procured from cadaveric donors four to 16 minutes after circulary arrest and were subsequently stored in the cold for approximately four hours. In one patient, the pancreatic duct was ligated, while in the other three, drainage was attained by suturing the transected end of the pancreas into a jejunal Roux-en-Y loop. Three of the grafts failed within six weeks as a result of irreversible refection, and one graft failed because of the early onset of venous thrombosis. The first sign of graft rejection was an increase in the postprandial blood sugar level, an increase in the fasting blood sugar level occurring several days later. Neither hyperamylasemia nor fever was observed. Radioisotope scans and angiograms were of great value in establishing the diagnosis of graft rejection. All of the patients survived after graft removal.
Insights
Segmental pancreas transplantation in diabetic patients showed early graft failure due to rejection or thrombosis. Early detection of graft rejection involved monitoring blood sugar levels.
Area of Science:
- Transplantation immunology
- Endocrinology
- Surgical innovation
Background:
- Type 1 diabetes mellitus (juvenile onset) poses significant management challenges.
- Hyperlabile diabetes and progressive vision loss are severe complications.
- Pancreas transplantation is a potential treatment for select diabetic patients.
Purpose of the Study:
- To evaluate the efficacy and outcomes of segmental pancreas body and tail transplantation.
- To assess graft survival and identify causes of graft failure in diabetic patients.
Main Methods:
- Segmental pancreas transplantation (body and tail) from cadaveric donors.
- Graft preservation for approximately four hours post-procurement.
- Pancreatic duct management: ligation in one patient, Roux-en-Y jejunal loop in three.
- Monitoring for graft rejection and complications.
Main Results:
- Three out of four grafts failed within six weeks due to irreversible rejection.
- One graft failed early due to venous thrombosis.
- Graft rejection manifested initially as increased postprandial, then fasting blood sugar levels.
- Radioisotope scans and angiograms were crucial for diagnosing rejection.
Conclusions:
- Segmental pancreas transplantation in this cohort had a high early failure rate.
- Graft rejection and venous thrombosis are significant challenges in pancreas transplantation.
- Early detection of rejection is possible through glycemic monitoring.