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Titolo:
Pancreas organ transplantation - Short and long-term results in terms of diabetes control
Autore:
Hopt, UT; Drognitz, O;
Indirizzi:
Univ Rostock, Dept Surg, D-18055 Rostock, Germany Univ Rostock Rostock Germany D-18055 Dept Surg, D-18055 Rostock, Germany
Titolo Testata:
LANGENBECKS ARCHIVES OF SURGERY
fascicolo: 6, volume: 385, anno: 2000,
pagine: 379 - 389
SICI:
1435-2443(200010)385:6<379:POT-SA>2.0.ZU;2-H
Fonte:
ISI
Lingua:
ENG
Soggetto:
QUALITY-OF-LIFE; KIDNEY-ALONE TRANSPLANTATION; PERIPHERAL VASCULAR-DISEASE; STAGE RENAL-DISEASE; METABOLIC CONTROL; NERVE-CONDUCTION; TACROLIMUS IMMUNOSUPPRESSION; ENTERIC DRAINAGE; GASTRIC FUNCTION; GLYCEMIC CONTROL;
Keywords:
pancreas transplantation; review; survival rate; diabetes mellitus; quality of life;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
115
Recensione:
Indirizzi per estratti:
Indirizzo: Hopt, UT Univ Rostock, Dept Surg, Schillingallee 35, D-18055 Rostock, Germany Univ Rostock Schillingallee 35 Rostock Germany D-18055 , Germany
Citazione:
U.T. Hopt e O. Drognitz, "Pancreas organ transplantation - Short and long-term results in terms of diabetes control", LANG ARCH S, 385(6), 2000, pp. 379-389

Abstract

Diabetes mellitus is a very common and dreadful disease which cannot be cured by exogenous insulin substitution. Many of the patients suffer from recurrent, and sometimes rather dangerous, hypo- or hyperglycemias and, in thelong term, from the well-known secondary diabetic complications. At the moment, pancreas transplantation is the only known therapy to reliably reestablish endogenous insulin secretion responsive to normal feed back controls. Within the last decade, pancreas transplantation has evolved as a clinically well-established procedure. Nevertheless, the perioperative risk after pancreas/kidney transplantation is still higher than after isolated kidney transplantation. However, the benefits of a functioning pancreas graft for the patients are enormous. Ten-year survival of type-I diabetic patients with combined pancreas/kidney grafts is dramatically better than of those withan isolated kidney graft. Long-term function of the pancreas grafts is excellent, reaching more than 60% after 10 years. Contrary to kidney transplantation, chronic rejection does not seem to be a major problem. Blood glucose levels in the fasting state, after glucose challenge, and in the postprandial state are completely normalized. A significant peripheral hyperinsulinemia, however, is found when the pancreas graft is connected to the systemic venous circulation. Thus, portal venous drainage of the pancreas graft, which is already being per formed by a few transplant centers routinely, might be the procedure of choice for the future. Beneficial effects on secondary diabetic lesions can only be expected aftera rather long observation period. In addition, for all secondary diabetic complications, there is a point of no return. Nevertheless, significant improvement of diabetic polyneuropathy, diabetic nephropathy, and the disturbed microcirculation has been convincingly demonstrated. The effect on diabetic retinopathy, however, is still controversial. One of the most impressiveeffects for the pancreas graft recipients seems to be the enormous improvement in quality of life, which is reported unanimously by almost all patients. Thus, simultaneous pancreas/kidney transplantation can be regarded as the optimal and only causal therapy for type-I diabetic patients with end-stage renal disease.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 12/07/20 alle ore 05:25:47