Reference : Kidney and Pancreas Transplantation : The history of Surgical Techniques and immunosu...
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Human health sciences : Surgery
Kidney and Pancreas Transplantation : The history of Surgical Techniques and immunosuppression
SQUIFFLET, Jean-Paul mailto [Centre Hospitalier Universitaire de Liège - CHU > > Chirurgie abdominale- endocrinienne et de transplantation >]
current issues and future direction in kidney transplantation
[en] Pancreas Transplantation aims at providing Beta cells replacement in diabetic patients,
especially for type 1 diabetes recipients in whom Beta cells had been destroyed by an autoimmune
process. The final achievement is to restore a normal physiological control of glucose
metabolism in order to halt or reverse the secondary complications of diabetes i.e. retinopathy,
neuropathy, nephropathy, micro – and macro - angiopathy [1]. That can be achieved by a
vascularised pancreas graft (referred as Pancreas Transplantation, PT) or by islet grafting
(referred as Islet Transplantation, IT). The former PT includes transplanting 95% of unuseful
cells, the exocrine part from one pancreas, while the last one IP, embolizing into the recipient
liver, Islets of Langerhans after digestion and purification of several human pancreases. Three
types of PT can be performed: the pancreas and a kidney are simultaneously transplanted with
a single induction of immunosuppression (IS) therapy in hoping to correct both uremia and
diabetes mellitus (SPK = Simultaneous Pancreas and Kidney Transplantation); the pancreas is
transplanted after a successful kidney graft allowing two induction therapies along with the
basic IS treatment (PAK = Pancreas After Kidney Transplantation) ; and finally the Pancreas
can be transplanted alone in pre-uremic recipients with unawareness hypoglycaemic events
or with rapidly evolving secondary complications of diabetes such as proliferative retinopathy,
or advanced neuropathy (PTA = Pancreas Transplantation Alone) [1].
Moreover, in SPK, both organs the Pancreas and the Kidney are procured from the same
deceased donor, either donor after brain death (DBD) or donor after cardiac death (DCD). In
some US institutions, a segmental pancreas and the left kidney, are procured in a living donor
[2], using a laparoscopic approach in the more recent year [3]. For PAK, in order to avoid an
excessive IS load and two induction therapies, other institutions had proposed whenever
possible to keep in stand-by the potential live kidney donor until a cadaver whole pancreatic compatible graft is available [1]. By contrast, the number of PTA remains limited in non uremic
recipients with life-threatening complications of diabetes, in whom one might hope to avoid
the hypoglycaemic events with a successful graft. That can also be achieved with IT. But except
for rare cases, insulin independence with IT requires more than a single human pancreas and
is limited over time [1]. Moreover, IT needs costly materials, chambers and rooms for preparation.
That’s why IT will not be included in the present report.
Researchers ; Professionals ; Students

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