A 10-year experience with 290 pancreas transplants at a single institution

D. E R Sutherland, D. L. Dunn, F. C. Goetz, W. Kennedy, R. C. Ramsay, M. W. Steffes, S. M. Mauer, R. Gruessner, C. Moudry-Munns, P. Morel, A. Viste, R. P. Robertson, J. S. Najarian

Research output: Contribution to journalArticle

118 Citations (Scopus)

Abstract

Since our report at the 1984 American Surgical Association meeting of 100 pancreas transplants from 1966 through 1983, another 190 have been performed. The current series, begun in 1978, now numbers 276 cases, and includes 133 nonuremic recipients of pancreas transplants alone (PTA), 46 simultaneous pancreas/kidney transplants (SPK), and 97 pancreas transplants after a kidney transplant (PAK). Duct management techniques used were free intraperitoneal drainage in 44 cases, duct occlusion in 44, enteric drainage in 89, and bladder drainage in 128. The 1-year patient and graft survival rates in the entire cohort of 276 were 91% and 42%. One-year patient survival rates were 88% in the first 100, 91% in the second 100, and 92% in the last 76 cases; corresponding 1-year graft survival rates were 28%, 47%, and 56% (p < 0.05). A prospective comparison of bladder drainage (n = 82) versus enteric drainage (n = 46) in PAK/PTA cases since November 1, 1984 favored bladder drainage (1-year graft survival rates of 52% vs. 41%) because of urinary amylase monitoring. The best results were in recipients of primary SPK bladder-drained transplants (n = 39), with a 1-year pancreas graft survival rate of 75%, kidney graft survival rate of 80%, and patient survival rate of 95%. Logistic regression analysis, with 1-year graft function as the independent variable, showed significant (p < 0.05) predictors of success (odds ratio) to be technique: bladder drainage (5.8) versus enteric drainage (2.5) versus duct injection (1.0); category: SPK (6.0) versus PAK from same donor (3.2) versus PAK from different donor (1.2) versus PTA (1.0); and donor HLA DR mismatch: 0 (5.0) versus 1 (2.5) versus 2 (1.0) antigens. On April 1, 1989, 90 patients had functioning grafts (60 euglycemic and insulin-free for more than 1 year, 10 for 5 to 10 years); these, along with 24 others whose grafts functioned for 1 to 6 years before failing, are part of an expanding cohort in whom the influence of inducing a euglycemic state on preexisting secondary complications of diabetes is being studied. Only preliminary data is available. In regard to neuropathy, at more than 1 year after transplant in patients with functioning grafts, conduction velocities in some nerves were increased over baseline. In regard to retinopathy, deterioration in grade occurred in approximately 30% of the recipients by 3 years, whether the graft functioned continuously or failed early, but thereafter retinopathy in the patients with functioning grafts remained stable. In patients with functioning pancreas grafts, kidney biopsies have shown a decreased glomerular mesangial volume compared to diabetic controls. Pancreas transplantation is increasingly successful in both uremic and nonuremic diabetic patients, and may ameliorate secondary complications of diabetes.

Original languageEnglish (US)
Pages (from-to)274-288
Number of pages15
JournalAnnals of surgery
Volume210
Issue number3
DOIs
StatePublished - Jan 1 1989

Fingerprint

Pancreas
Transplants
Drainage
Survival Rate
Graft Survival
Urinary Bladder
Kidney
Diabetes Complications
Tissue Donors
Pancreas Transplantation
HLA-DR Antigens
Amylases
Logistic Models
Odds Ratio
Regression Analysis

Cite this

Sutherland, D. E. R., Dunn, D. L., Goetz, F. C., Kennedy, W., Ramsay, R. C., Steffes, M. W., ... Najarian, J. S. (1989). A 10-year experience with 290 pancreas transplants at a single institution. Annals of surgery, 210(3), 274-288. https://doi.org/10.1097/00000658-198909000-00003

A 10-year experience with 290 pancreas transplants at a single institution. / Sutherland, D. E R; Dunn, D. L.; Goetz, F. C.; Kennedy, W.; Ramsay, R. C.; Steffes, M. W.; Mauer, S. M.; Gruessner, R.; Moudry-Munns, C.; Morel, P.; Viste, A.; Robertson, R. P.; Najarian, J. S.

In: Annals of surgery, Vol. 210, No. 3, 01.01.1989, p. 274-288.

Research output: Contribution to journalArticle

Sutherland, DER, Dunn, DL, Goetz, FC, Kennedy, W, Ramsay, RC, Steffes, MW, Mauer, SM, Gruessner, R, Moudry-Munns, C, Morel, P, Viste, A, Robertson, RP & Najarian, JS 1989, 'A 10-year experience with 290 pancreas transplants at a single institution', Annals of surgery, vol. 210, no. 3, pp. 274-288. https://doi.org/10.1097/00000658-198909000-00003
Sutherland, D. E R ; Dunn, D. L. ; Goetz, F. C. ; Kennedy, W. ; Ramsay, R. C. ; Steffes, M. W. ; Mauer, S. M. ; Gruessner, R. ; Moudry-Munns, C. ; Morel, P. ; Viste, A. ; Robertson, R. P. ; Najarian, J. S. / A 10-year experience with 290 pancreas transplants at a single institution. In: Annals of surgery. 1989 ; Vol. 210, No. 3. pp. 274-288.
@article{8e492faad8cd43d18b8a0b884a2c77c5,
title = "A 10-year experience with 290 pancreas transplants at a single institution",
abstract = "Since our report at the 1984 American Surgical Association meeting of 100 pancreas transplants from 1966 through 1983, another 190 have been performed. The current series, begun in 1978, now numbers 276 cases, and includes 133 nonuremic recipients of pancreas transplants alone (PTA), 46 simultaneous pancreas/kidney transplants (SPK), and 97 pancreas transplants after a kidney transplant (PAK). Duct management techniques used were free intraperitoneal drainage in 44 cases, duct occlusion in 44, enteric drainage in 89, and bladder drainage in 128. The 1-year patient and graft survival rates in the entire cohort of 276 were 91{\%} and 42{\%}. One-year patient survival rates were 88{\%} in the first 100, 91{\%} in the second 100, and 92{\%} in the last 76 cases; corresponding 1-year graft survival rates were 28{\%}, 47{\%}, and 56{\%} (p < 0.05). A prospective comparison of bladder drainage (n = 82) versus enteric drainage (n = 46) in PAK/PTA cases since November 1, 1984 favored bladder drainage (1-year graft survival rates of 52{\%} vs. 41{\%}) because of urinary amylase monitoring. The best results were in recipients of primary SPK bladder-drained transplants (n = 39), with a 1-year pancreas graft survival rate of 75{\%}, kidney graft survival rate of 80{\%}, and patient survival rate of 95{\%}. Logistic regression analysis, with 1-year graft function as the independent variable, showed significant (p < 0.05) predictors of success (odds ratio) to be technique: bladder drainage (5.8) versus enteric drainage (2.5) versus duct injection (1.0); category: SPK (6.0) versus PAK from same donor (3.2) versus PAK from different donor (1.2) versus PTA (1.0); and donor HLA DR mismatch: 0 (5.0) versus 1 (2.5) versus 2 (1.0) antigens. On April 1, 1989, 90 patients had functioning grafts (60 euglycemic and insulin-free for more than 1 year, 10 for 5 to 10 years); these, along with 24 others whose grafts functioned for 1 to 6 years before failing, are part of an expanding cohort in whom the influence of inducing a euglycemic state on preexisting secondary complications of diabetes is being studied. Only preliminary data is available. In regard to neuropathy, at more than 1 year after transplant in patients with functioning grafts, conduction velocities in some nerves were increased over baseline. In regard to retinopathy, deterioration in grade occurred in approximately 30{\%} of the recipients by 3 years, whether the graft functioned continuously or failed early, but thereafter retinopathy in the patients with functioning grafts remained stable. In patients with functioning pancreas grafts, kidney biopsies have shown a decreased glomerular mesangial volume compared to diabetic controls. Pancreas transplantation is increasingly successful in both uremic and nonuremic diabetic patients, and may ameliorate secondary complications of diabetes.",
author = "Sutherland, {D. E R} and Dunn, {D. L.} and Goetz, {F. C.} and W. Kennedy and Ramsay, {R. C.} and Steffes, {M. W.} and Mauer, {S. M.} and R. Gruessner and C. Moudry-Munns and P. Morel and A. Viste and Robertson, {R. P.} and Najarian, {J. S.}",
year = "1989",
month = "1",
day = "1",
doi = "10.1097/00000658-198909000-00003",
language = "English (US)",
volume = "210",
pages = "274--288",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - A 10-year experience with 290 pancreas transplants at a single institution

AU - Sutherland, D. E R

AU - Dunn, D. L.

AU - Goetz, F. C.

AU - Kennedy, W.

AU - Ramsay, R. C.

AU - Steffes, M. W.

AU - Mauer, S. M.

AU - Gruessner, R.

AU - Moudry-Munns, C.

AU - Morel, P.

AU - Viste, A.

AU - Robertson, R. P.

AU - Najarian, J. S.

PY - 1989/1/1

Y1 - 1989/1/1

N2 - Since our report at the 1984 American Surgical Association meeting of 100 pancreas transplants from 1966 through 1983, another 190 have been performed. The current series, begun in 1978, now numbers 276 cases, and includes 133 nonuremic recipients of pancreas transplants alone (PTA), 46 simultaneous pancreas/kidney transplants (SPK), and 97 pancreas transplants after a kidney transplant (PAK). Duct management techniques used were free intraperitoneal drainage in 44 cases, duct occlusion in 44, enteric drainage in 89, and bladder drainage in 128. The 1-year patient and graft survival rates in the entire cohort of 276 were 91% and 42%. One-year patient survival rates were 88% in the first 100, 91% in the second 100, and 92% in the last 76 cases; corresponding 1-year graft survival rates were 28%, 47%, and 56% (p < 0.05). A prospective comparison of bladder drainage (n = 82) versus enteric drainage (n = 46) in PAK/PTA cases since November 1, 1984 favored bladder drainage (1-year graft survival rates of 52% vs. 41%) because of urinary amylase monitoring. The best results were in recipients of primary SPK bladder-drained transplants (n = 39), with a 1-year pancreas graft survival rate of 75%, kidney graft survival rate of 80%, and patient survival rate of 95%. Logistic regression analysis, with 1-year graft function as the independent variable, showed significant (p < 0.05) predictors of success (odds ratio) to be technique: bladder drainage (5.8) versus enteric drainage (2.5) versus duct injection (1.0); category: SPK (6.0) versus PAK from same donor (3.2) versus PAK from different donor (1.2) versus PTA (1.0); and donor HLA DR mismatch: 0 (5.0) versus 1 (2.5) versus 2 (1.0) antigens. On April 1, 1989, 90 patients had functioning grafts (60 euglycemic and insulin-free for more than 1 year, 10 for 5 to 10 years); these, along with 24 others whose grafts functioned for 1 to 6 years before failing, are part of an expanding cohort in whom the influence of inducing a euglycemic state on preexisting secondary complications of diabetes is being studied. Only preliminary data is available. In regard to neuropathy, at more than 1 year after transplant in patients with functioning grafts, conduction velocities in some nerves were increased over baseline. In regard to retinopathy, deterioration in grade occurred in approximately 30% of the recipients by 3 years, whether the graft functioned continuously or failed early, but thereafter retinopathy in the patients with functioning grafts remained stable. In patients with functioning pancreas grafts, kidney biopsies have shown a decreased glomerular mesangial volume compared to diabetic controls. Pancreas transplantation is increasingly successful in both uremic and nonuremic diabetic patients, and may ameliorate secondary complications of diabetes.

AB - Since our report at the 1984 American Surgical Association meeting of 100 pancreas transplants from 1966 through 1983, another 190 have been performed. The current series, begun in 1978, now numbers 276 cases, and includes 133 nonuremic recipients of pancreas transplants alone (PTA), 46 simultaneous pancreas/kidney transplants (SPK), and 97 pancreas transplants after a kidney transplant (PAK). Duct management techniques used were free intraperitoneal drainage in 44 cases, duct occlusion in 44, enteric drainage in 89, and bladder drainage in 128. The 1-year patient and graft survival rates in the entire cohort of 276 were 91% and 42%. One-year patient survival rates were 88% in the first 100, 91% in the second 100, and 92% in the last 76 cases; corresponding 1-year graft survival rates were 28%, 47%, and 56% (p < 0.05). A prospective comparison of bladder drainage (n = 82) versus enteric drainage (n = 46) in PAK/PTA cases since November 1, 1984 favored bladder drainage (1-year graft survival rates of 52% vs. 41%) because of urinary amylase monitoring. The best results were in recipients of primary SPK bladder-drained transplants (n = 39), with a 1-year pancreas graft survival rate of 75%, kidney graft survival rate of 80%, and patient survival rate of 95%. Logistic regression analysis, with 1-year graft function as the independent variable, showed significant (p < 0.05) predictors of success (odds ratio) to be technique: bladder drainage (5.8) versus enteric drainage (2.5) versus duct injection (1.0); category: SPK (6.0) versus PAK from same donor (3.2) versus PAK from different donor (1.2) versus PTA (1.0); and donor HLA DR mismatch: 0 (5.0) versus 1 (2.5) versus 2 (1.0) antigens. On April 1, 1989, 90 patients had functioning grafts (60 euglycemic and insulin-free for more than 1 year, 10 for 5 to 10 years); these, along with 24 others whose grafts functioned for 1 to 6 years before failing, are part of an expanding cohort in whom the influence of inducing a euglycemic state on preexisting secondary complications of diabetes is being studied. Only preliminary data is available. In regard to neuropathy, at more than 1 year after transplant in patients with functioning grafts, conduction velocities in some nerves were increased over baseline. In regard to retinopathy, deterioration in grade occurred in approximately 30% of the recipients by 3 years, whether the graft functioned continuously or failed early, but thereafter retinopathy in the patients with functioning grafts remained stable. In patients with functioning pancreas grafts, kidney biopsies have shown a decreased glomerular mesangial volume compared to diabetic controls. Pancreas transplantation is increasingly successful in both uremic and nonuremic diabetic patients, and may ameliorate secondary complications of diabetes.

UR - http://www.scopus.com/inward/record.url?scp=0024349954&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0024349954&partnerID=8YFLogxK

U2 - 10.1097/00000658-198909000-00003

DO - 10.1097/00000658-198909000-00003

M3 - Article

VL - 210

SP - 274

EP - 288

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 3

ER -