simultaneous pancreas-kidney transplant

• 膵腎同時移植

関

simultaneous pancreas and kidney transplantation、simultaneous pancreas-kidney transplantation

WordNet

1. be transplantable; "These delicate plants do not transplant easily"
2. an operation moving an organ from one organism (the donor) to another (the recipient); "he had a kidney transplant"; "the long-term results of cardiac transplantation are now excellent"; "a child had a multiple organ transplant two months ago" (同)transplantation, organ_transplant
3. the act of removing something from one location and introducing it in another location; "the transplant did not flower until the second year"; "too frequent transplanting is not good for families"; "she returned to Alabama because she could not bear transplantation" (同)transplantation, transplanting
4. place the organ of a donor into the body of a recipient (同)graft
5. lift and reset in another soil or situation; "Transplant the young rice plants" (同)transfer
6. either of two bean-shaped excretory organs that filter wastes (especially urea) from the blood and excrete them and water in urine; "urine passes out of the kidney through ureters to the bladder"
7. a large elongated exocrine gland located behind the stomach; secretes pancreatic juice and insulin

PrepTutorEJDIC

1. 〈植物〉‘を'移植する / (…から他の場所へ)…‘を'移す,〈人〉‘を'移住させる《+名+from+名+to+名》 / (…から…へ)〈組織・器官など〉‘を'移植する《+名+from+名+to+名》 / 移植できる;移住する / 〈C〉移植された物 / 〈U〉移植すること
2. 同時の;(…と)同時に起こる《+『with』+『名』》
3. 腎臓;(食品としての)羊(豚など)の腎臓 / 《文》気質,性質,たち(nature)
4. 膵臓(すいぞう)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/01/18 05:34:38」(JST)

wiki en

[Wiki en表示]

Pancreas transplantation
Intervention
Pancreas transplant ex-situ prepared with reconstruction of arteries and lengthening of the portal vein
ICD-9-CM	52.8
MeSH	D016035
MedlinePlus	003007

A pancreas transplant is an organ transplant that involves implanting a healthy pancreas (one that can produce insulin) into a person who usually has diabetes. Because the pancreas is a vital organ (losing all of the pancreas leaves a person with a very, very serious case of total diabetes called brittle diabetes), performing functions necessary in the digestion process, the recipient's native pancreas is left in place, and the donated pancreas is attached in a different location. In the event of rejection of the new pancreas, which would quickly cause life-threatening diabetes, there would be a significant chance the recipient would not survive very well for long without the native pancreas, however dysfunctional, still in place. The healthy pancreas comes from a donor who has just died or it may be a partial pancreas from a living donor. At present, pancreas transplants are usually performed in persons with insulin-dependent diabetes, who can develop severe complications. Patients with the most common- and deadliest- form of pancreatic cancer (pancreatic adenomas- which are usually always malignant, with a poor prognosis and high risk for metastasis- as opposed to more treatable pancreatic neuroendocrine tumors or pancreatic insulinomas) are usually not eligible for valuable pancreatic transplantations, since the condition usually has a very high mortality rate and the disease, which is usually highly malignant and detected too late to treat, could and probably would soon return.

Medical uses

In most cases, pancreas transplantation is performed on individuals with type 1 diabetes with end-stage renal disease, brittle diabetes and hypoglycaemia unawareness. The majority of pancreas transplantation (>90%) are simultaneous pancreas-kidney transplantation. It may also be performed as part of a kidney-pancreas transplantation.

Complications

Complications immediately after surgery include thrombosis, pancreatitis, infection, bleeding and rejection. Rejection may occur immediately or at any time during the patient's life. This is because the transplanted pancreas comes from another organism, thus the recipient's immune system will consider it as an aggression and try to combat it. Organ rejection is a serious condition and ought to be treated immediately. In order to prevent it, patients must take a regimen of immunosuppressive drugs. Drugs are taken in combination consisting normally of ciclosporin, azathioprine and corticosteroids. But as episodes of rejection may reoccur throughout a patient's life, the exact choices and dosages of immunosuppressants may have to be modified over time. Sometimes tacrolimus is given instead of ciclosporin and mycophenolate mofetil instead of azathioprine.

Types

There are four main types of pancreas transplantation:

• Pancreas transplant alone, for the patient with type 1 diabetes who usually has severe, frequent hypoglycemia, but adequate kidney function.
• Simultaneous pancreas-kidney transplant (SPK), when the pancreas and kidney are transplanted simultaneously from the same deceased donor.
• Pancreas-after-kidney transplant (PAK), when a cadaveric, or deceased, donor pancreas transplant is performed after a previous, and different, living or deceased donor kidney transplant.
• Simultaneous deceased donor pancreas and live donor kidney (SPLK) has the benefit of lower rate of delayed graft function than SPK and significantly reduced waiting times, resulting in improved outcomes.

Preservation until implantation

Standard practice is to replace the donor's blood in the pancreatic tissue with an ice-cold organ storage solution, such as UW (Viaspan) or HTK until the allograft pancreatic tissue is implanted.

Prognosis

The prognosis after pancreas transplantation is very good. Over the recent years, long-term success has improved and risks have decreased. One year after transplantation more than 95% of all patients are still alive and 80-85% of all pancreases are still functional. After transplantation patients need lifelong immunosuppression. Immunosuppression increases the risk for a number of different kinds of infection and cancer.

It is unclear if steroids, which are often used as immunosuppressant, can be replaced with something else.

History

As described by a pioneer in the field, D.E. Sutherland, whole pancreas transplantation began as a part of multi-organ transplants, in the mid-to-late 1960s, at the University of Minnesota:

The first attempt to cure type 1 diabetes by pancreas transplantation was done at the University of Minnesota, in Minneapolis, on December 17, 1966… [This] opened the door to a period, between the mid 70's to mid 80's where only segmental pancreatic grafts were used... In the late 70's-early 80's, three major events… boosted the development of pancreas transplantation… [At] the Spitzingsee meetings, participants had the idea to renew the urinary drainage technique of the exocrine secretion of the pancreatic graft with segmental graft and eventually with whole pancreaticoduodenal transplant. That was clinically achieved during the mid 80's and remained the mainstay technique during the next decade. In parallel, the Swedish group developed the whole pancreas transplantation technique with enteric diversion. It was the onset of the whole pancreas reign. The enthusiasm for the technique was rather moderated in its early phase due to the rapid development of liver transplantation and the need for sharing vascular structures between both organs, liver and pancreas. During the modern era of immunosuppression, the whole pancreas transplantation technique with enteric diversion became the gold standard…

The first pancreas transplantation, performed in a multi-organ transplant with kidney and duodenum, was into a 28-year-old woman; her death three month post-surgery did not obscure the apparent success of the pancreatic replacement. It was performed 1966 by the team of W.D. Kelly, R.C. Lillehei, F.K. Merkel, Y. Idezuki, F.C. Goetz and coworkers at the University Hospitals, University of Minnesota, three years after the first kidney transplantation. The first living-related partial pancreas transplantation was done in 1979.

References

Further reading

• Larsen JL (2004). "Pancreas transplantation: indications and consequences". Endocr Rev. 25 (6): 919–46. doi:10.1210/er.2002-0036. PMID 15583023.  Full text

External links

• VIDEO - Last 10 years of pancreas transplantation, by Dixon Kaufman, MD, PhD. University of Wisconsin School of Medicine and Public Health, 2011.
• Diabetes Institute for Immunology and Transplantation
• International Pancreas and Islet Transplant Association
• Pancreas transplantation at the University of Illinois at Chicago

UpToDate Contents

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• 1. 糖尿病における腎臓・膵臓移植と関連した利益および合併症 benefits and complications associated with kidney pancreas transplantation in diabetes mellitus
• 2. 糖尿病を合併した腎臓・膵臓移植での患者選択とそれに関連する免疫学的問題 patient selection for and immunologic issues relating to kidney pancreas transplantation in diabetes mellitus
• 3. 糖尿病における膵臓および膵島移植 pancreas and islet transplantation in diabetes mellitus
• 4. 糖尿病性腎症における腎移植 renal transplantation in diabetic nephropathy
• 5. 腎移植後の赤血球増多症 erythrocytosis following renal transplantation

English Journal

• Long-term Outcomes for Living Pancreas Donors in the Modern Era.

• Kirchner VA1, Finger EB, Bellin MD, Dunn TB, Gruessner RW, Hering BJ, Humar A, Kukla AK, Matas AJ, Pruett TL, Sutherland DE, Kandaswamy R.
• Transplantation.Transplantation.2016 Jun;100(6):1322-8. doi: 10.1097/TP.0000000000001250.
• BACKGROUND: Living donor segmental pancreas transplants (LDSPTx) have been performed selectively to offer a preemptive transplant option for simultaneous pancreas-kidney recipients and to perform a single operation decreasing the cost of pancreas after kidney transplant. For solitary pancreas transp
• PMID 27203593

• Pancreas Transplantation: An Alarming Crisis in Confidence.

• Stratta RJ1, Gruessner AC2, Odorico JS3, Fridell JA4, Gruessner RW2.
• American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.Am J Transplant.2016 May 27. doi: 10.1111/ajt.13890. [Epub ahead of print]
• In the past decade, the annual number of pancreas transplants performed in the United States (US) has steadily declined. From 2004-2011, the overall number of simultaneous pancreas-kidney (SPK) transplants in the US declined by 10% whereas the decreases in pancreas after kidney (PAK) and pancreas tr
• PMID 27232750

• Impact of graft implantation order on graft survival in simultaneous pancreas-kidney transplantation.

• Niclauss N1, Bédat B1, Morel P1, Andres A1, Toso C1, Berney T1.
• Transplant international : official journal of the European Society for Organ Transplantation.Transpl Int.2016 May;29(5):627-35. doi: 10.1111/tri.12773.
• The optimal order of revascularization for pancreas and kidney grafts in simultaneous pancreas-kidney transplantation has not been established. In this study, we investigate the influence of graft implantation order on graft survival in SPK. 12 700 transplantations from the Scientific Registry of T
• PMID 26987785

Japanese Journal

• 単施設における膵腎同時移植および腎移植後膵移植の成績

• 日本臨床腎移植学会雑誌 = Journal of Japanese Society for Clinical Renal Transplantation 3(2), 195-201, 2015-12
• NAID 40020688921

• 膵腎同時移植後に遅発性移植十二指腸穿孔を来した1例

• 日本消化器外科学会雑誌 48(11), 929-935, 2015
• NAID 130005110839

• 膵臓移植における内科医の役割

• 移植 50(2-3), 106-111, 2015
• NAID 130005093530

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★リンクテーブル★

リンク元	「膵腎同時移植」「simultaneous pancreas and kidney transplantation」
拡張検索	「simultaneous pancreas-kidney transplantation」
関連記事	「transplant」「simultaneous」「kidney」

「膵腎同時移植」

　　[★]

英

simultaneous pancreas-kidney transplant、simultaneous pancreas-kidney transplantation、simultaneous pancreas and kidney transplantation

「simultaneous pancreas and kidney transplantation」

　　[★]

• 膵腎同時移植

関

simultaneous pancreas-kidney transplant、simultaneous pancreas-kidney transplantation

「simultaneous pancreas-kidney transplantation」

　　[★]

• 膵腎同時移植

関

simultaneous pancreas and kidney transplantation、simultaneous pancreas-kidney transplant

「transplant」

　　[★]

• n.

• 移植片、移植

• v.

• 移植する

関

cell transplant、engraft、engraftment、explant、graft、grafting、implant、implantation、organ graft、organ transplant、tissue graft、tissue transplant、transfer、transplant recipient、transplantation

　 　 　 　 　 　

「simultaneous」

　　[★]

• adj.

• 同時の、併発した、(数学)連立の

関

accompany、coincidence、coincident、coincidental、coincidentally、concomitant、concomitantly、concur、concurrent、concurrently、involvement、simultaneously、supervene、synchronous、synchronously

　

「kidney」

　　[★] 腎臓

同

KUB