Pancreas Biopsy

14,000,000 Leading Edge Experts on the ideXlab platform

Scan Science and Technology

Contact Leading Edge Experts & Companies

Scan Science and Technology

Contact Leading Edge Experts & Companies

The Experts below are selected from a list of 42 Experts worldwide ranked by ideXlab platform

Do Hyun Park - One of the best experts on this subject based on the ideXlab platform.

Min Kyung Jeon - One of the best experts on this subject based on the ideXlab platform.

Stephen T. Bartlett - One of the best experts on this subject based on the ideXlab platform.

  • simultaneous cadaver Pancreas living donor kidney transplantation a new approach for the type 1 diabetic uremic patient
    Annals of Surgery, 2000
    Co-Authors: Alan C Farney, Eugene J. Schweitzer, Eugene Cho, Brian J Dunkin, Benjamin Philosophe, John O Colonna, Stephen C Jacobs, Bruce Jarrell, John L Flowers, Stephen T. Bartlett
    Abstract:

    Simultaneous cadaver kidney Pancreas transplantation (SPK) and sequential Pancreas after kidney transplantation (PAK) are typically the only options for uremic or posturemic Type 1 diabetic patients who wish to undergo Pancreas transplantation. Together they account for more than 99% of all Pancreas transplants for uremic or posturemic diabetic patients. 1 SPK transplantation is more widely used than KTA followed by PAK, because SPK is a single operation and there is an “immunologic advantage” for the Pancreas because the kidney can serve as a reliable marker for rejection of the Pancreas. 2 However, some advocate PAK transplantation if there is a willing living kidney donor. 3 Use of a well-matched living-donor kidney can double the expected renal allograft survival half-life. 4 Living kidney donation also shortens the waiting time for transplantation and expands the organ donor pool. 5 The 1-year Pancreas graft survival rate for SPK transplantation is now 83%. 1 During the past 3 to 4 years, the 1-year Pancreas graft survival rate for PAK recipients has improved from 54% survival to 71%, shrinking the “immunologic advantage” of combining a cadaver Pancreas with a kidney from the same donor. 1,3,6 The use of percutaneous Pancreas Biopsy coupled with tacrolimus-based immunosuppression results in equivalent success of solitary Pancreas and SPK transplantation. 3 Largely because of these results, and because of the distinct advantages of living kidney donation, we have developed a new approach for uremic Type 1 diabetic patients: simultaneous cadaver-donor Pancreas and living-donor kidney transplantation (SPLK). More than half of our uremic type I diabetic patients who desire Pancreas transplantation now opt for SPLK. Selection of SPLK is generally limited only by the availability of a living donor. As a single procedure, SPLK has obvious advantages over the standard living-donor kidney transplant followed by PAK. Moreover, because the SPLK kidney is from a living donor, there may be both short-term and long-term benefits over SPK transplantation. Potential benefits of SPLK for Type 1 diabetic uremic patients include a shorter waiting time for transplantation and better early and long-term renal graft function. Generalized use of SPLK transplantation would expand the renal organ donor pool, thus benefiting all patients waiting for a kidney transplant. The main drawback to SPLK, coordination of a living donor nephrectomy with a cadaver Pancreas transplant, is easily overcome. This paper describes the technique of SPLK and reviews the results of our first 30 consecutive cases. Comparison is made with contemporaneous consecutive series of primary SPK and PAK transplants.

  • simultaneous Pancreas kidney transplantation a comparison of enteric and bladder drainage of exocrine pancreatic secretions
    Transplantation, 1997
    Co-Authors: Paul C Kuo, Eugene J. Schweitzer, Lynt B Johnson, Stephen T. Bartlett
    Abstract:

    Simultaneous Pancreas/kidney transplantation (SPK) has evolved to become a therapeutic option for patients with renal failure resulting from type 1 diabetes mellitus. However, the appropriate route for drainage of the exocrine secretions of the Pancreas allograft remains unclear. While bladder drainage (BD) is the current state of the art, it is associated with a high frequency of urologic complications, including urinary tract infections, hematuria, metabolic acidosis, dehydration, and reflux pancreatitis. Although enteric drainage (ED) is the more physiologic route, it has been associated in the past with decreased graft survival and increased infectious complications. In addition, BD offered a technique for detection of rejection through measurement of urinary amylase. However, with the advent of improved immunosuppression and antibiotic therapy, percutaneous Pancreas Biopsy, improved radiologic imaging, and greater understanding of Pancreas transplantation, we hypothesized that ED could be performed without increased morbidity or cost. A group of 23 consecutive SPK was performed with ED during the period from July 1995 to November 1995. Another 23 age- and sex-matched recipients of SPK with BD performed from November 1994 to June 1995 served as a historical control group. Because of the differing lengths of follow-up, data were analyzed with respect to the first six months posttransplant. ED and BD were associated with equivalent actuarial one-year patient and graft survival rates: 100% and 88% for ED, and 96% and 91% for BD, respectively. Hospital charges, length of stay, readmissions, rejection, sepsis-related procedures were also equivalent in ED and BD. However, ED was associated with significantly fewer urinary tract infections and urologic complications. In addition, no grafts were lost as the result of sepsis. In the setting of SPK, ED represents a viable alternative to BD for primary drainage of Pancreas exocrine secretions. Further studies with extended lengths of follow-up are necessary to confirm our observations.

  • equivalent success of simultaneous Pancreas kidney and solitary Pancreas transplantation a prospective trial of tacrolimus immunosuppression with percutaneous Biopsy
    Annals of Surgery, 1996
    Co-Authors: Stephen T. Bartlett, Edward W Hoehnsaric, Eugene J. Schweitzer, Lynt B Johnson, John C Papadimitriou, David K. Klassen, Cinthia B Drachenberg, Matthew R Weir, Anthony L Imbembo
    Abstract:

    Objective This study was designed to evaluate the results of solitary Pancreas transplantation in a protocol that uses the new immunosuppressant tacrolimus (FK) and liberally applies ultrasound-guided percutaneous Pancreas Biopsy to diagnose rejection. Summary Background Data Pancreas graft survival in patients who simultaneously receive a kidney transplant (SPK) historically has been 75% to 90% at 1 year, approaching that of cadaveric kidney transplantations. In sharp contrast, graft survival rates in patients who receive a Pancreas alone (PA) have remained static over the past decade, with approximately 50% functional at 1 year. It was hypothesized that the results of PA transplantations would improve with newer maintenance immunosuppressants and Biopsy techniques. Methods Twenty-seven PA recipients prospectively were treated with FK-based immunosuppression (PA-FK). Percutaneous Biopsy was performed for hyperamylasemia, hyperlipasemia, hypoamylasuria, or unexplained fever. One year Pancreas graft survival in these patients was compared to 15 cyclosporine treated PA cases (PA-CsA) and 113 SPK recipients. Results The 1-year Pancreas graft survival rate of 90.1% in technically successful PA-FK patients was significantly better than the 53.4% rate in PA-CsA recipients (p = 0.002) and no different than the 87.4% rate in SPK recipients. The only graft lost to acute rejection in the PA-FK group was because of acknowledged patient noncompliance. Percutaneous Biopsy substantially improved the diagnostic certainty in cases of suspected rejection and was associated with a low complication rate (3/178 = 1.5%). Conclusions Modern immunosuppression and Biopsy techniques have improved the success of solitary Pancreas transplantations to the point where outcome is now equivalent to that of SPKs.

Hoonsub So - One of the best experts on this subject based on the ideXlab platform.

Eugene J. Schweitzer - One of the best experts on this subject based on the ideXlab platform.

  • simultaneous cadaver Pancreas living donor kidney transplantation a new approach for the type 1 diabetic uremic patient
    Annals of Surgery, 2000
    Co-Authors: Alan C Farney, Eugene J. Schweitzer, Eugene Cho, Brian J Dunkin, Benjamin Philosophe, John O Colonna, Stephen C Jacobs, Bruce Jarrell, John L Flowers, Stephen T. Bartlett
    Abstract:

    Simultaneous cadaver kidney Pancreas transplantation (SPK) and sequential Pancreas after kidney transplantation (PAK) are typically the only options for uremic or posturemic Type 1 diabetic patients who wish to undergo Pancreas transplantation. Together they account for more than 99% of all Pancreas transplants for uremic or posturemic diabetic patients. 1 SPK transplantation is more widely used than KTA followed by PAK, because SPK is a single operation and there is an “immunologic advantage” for the Pancreas because the kidney can serve as a reliable marker for rejection of the Pancreas. 2 However, some advocate PAK transplantation if there is a willing living kidney donor. 3 Use of a well-matched living-donor kidney can double the expected renal allograft survival half-life. 4 Living kidney donation also shortens the waiting time for transplantation and expands the organ donor pool. 5 The 1-year Pancreas graft survival rate for SPK transplantation is now 83%. 1 During the past 3 to 4 years, the 1-year Pancreas graft survival rate for PAK recipients has improved from 54% survival to 71%, shrinking the “immunologic advantage” of combining a cadaver Pancreas with a kidney from the same donor. 1,3,6 The use of percutaneous Pancreas Biopsy coupled with tacrolimus-based immunosuppression results in equivalent success of solitary Pancreas and SPK transplantation. 3 Largely because of these results, and because of the distinct advantages of living kidney donation, we have developed a new approach for uremic Type 1 diabetic patients: simultaneous cadaver-donor Pancreas and living-donor kidney transplantation (SPLK). More than half of our uremic type I diabetic patients who desire Pancreas transplantation now opt for SPLK. Selection of SPLK is generally limited only by the availability of a living donor. As a single procedure, SPLK has obvious advantages over the standard living-donor kidney transplant followed by PAK. Moreover, because the SPLK kidney is from a living donor, there may be both short-term and long-term benefits over SPK transplantation. Potential benefits of SPLK for Type 1 diabetic uremic patients include a shorter waiting time for transplantation and better early and long-term renal graft function. Generalized use of SPLK transplantation would expand the renal organ donor pool, thus benefiting all patients waiting for a kidney transplant. The main drawback to SPLK, coordination of a living donor nephrectomy with a cadaver Pancreas transplant, is easily overcome. This paper describes the technique of SPLK and reviews the results of our first 30 consecutive cases. Comparison is made with contemporaneous consecutive series of primary SPK and PAK transplants.

  • simultaneous Pancreas kidney transplantation a comparison of enteric and bladder drainage of exocrine pancreatic secretions
    Transplantation, 1997
    Co-Authors: Paul C Kuo, Eugene J. Schweitzer, Lynt B Johnson, Stephen T. Bartlett
    Abstract:

    Simultaneous Pancreas/kidney transplantation (SPK) has evolved to become a therapeutic option for patients with renal failure resulting from type 1 diabetes mellitus. However, the appropriate route for drainage of the exocrine secretions of the Pancreas allograft remains unclear. While bladder drainage (BD) is the current state of the art, it is associated with a high frequency of urologic complications, including urinary tract infections, hematuria, metabolic acidosis, dehydration, and reflux pancreatitis. Although enteric drainage (ED) is the more physiologic route, it has been associated in the past with decreased graft survival and increased infectious complications. In addition, BD offered a technique for detection of rejection through measurement of urinary amylase. However, with the advent of improved immunosuppression and antibiotic therapy, percutaneous Pancreas Biopsy, improved radiologic imaging, and greater understanding of Pancreas transplantation, we hypothesized that ED could be performed without increased morbidity or cost. A group of 23 consecutive SPK was performed with ED during the period from July 1995 to November 1995. Another 23 age- and sex-matched recipients of SPK with BD performed from November 1994 to June 1995 served as a historical control group. Because of the differing lengths of follow-up, data were analyzed with respect to the first six months posttransplant. ED and BD were associated with equivalent actuarial one-year patient and graft survival rates: 100% and 88% for ED, and 96% and 91% for BD, respectively. Hospital charges, length of stay, readmissions, rejection, sepsis-related procedures were also equivalent in ED and BD. However, ED was associated with significantly fewer urinary tract infections and urologic complications. In addition, no grafts were lost as the result of sepsis. In the setting of SPK, ED represents a viable alternative to BD for primary drainage of Pancreas exocrine secretions. Further studies with extended lengths of follow-up are necessary to confirm our observations.

  • equivalent success of simultaneous Pancreas kidney and solitary Pancreas transplantation a prospective trial of tacrolimus immunosuppression with percutaneous Biopsy
    Annals of Surgery, 1996
    Co-Authors: Stephen T. Bartlett, Edward W Hoehnsaric, Eugene J. Schweitzer, Lynt B Johnson, John C Papadimitriou, David K. Klassen, Cinthia B Drachenberg, Matthew R Weir, Anthony L Imbembo
    Abstract:

    Objective This study was designed to evaluate the results of solitary Pancreas transplantation in a protocol that uses the new immunosuppressant tacrolimus (FK) and liberally applies ultrasound-guided percutaneous Pancreas Biopsy to diagnose rejection. Summary Background Data Pancreas graft survival in patients who simultaneously receive a kidney transplant (SPK) historically has been 75% to 90% at 1 year, approaching that of cadaveric kidney transplantations. In sharp contrast, graft survival rates in patients who receive a Pancreas alone (PA) have remained static over the past decade, with approximately 50% functional at 1 year. It was hypothesized that the results of PA transplantations would improve with newer maintenance immunosuppressants and Biopsy techniques. Methods Twenty-seven PA recipients prospectively were treated with FK-based immunosuppression (PA-FK). Percutaneous Biopsy was performed for hyperamylasemia, hyperlipasemia, hypoamylasuria, or unexplained fever. One year Pancreas graft survival in these patients was compared to 15 cyclosporine treated PA cases (PA-CsA) and 113 SPK recipients. Results The 1-year Pancreas graft survival rate of 90.1% in technically successful PA-FK patients was significantly better than the 53.4% rate in PA-CsA recipients (p = 0.002) and no different than the 87.4% rate in SPK recipients. The only graft lost to acute rejection in the PA-FK group was because of acknowledged patient noncompliance. Percutaneous Biopsy substantially improved the diagnostic certainty in cases of suspected rejection and was associated with a low complication rate (3/178 = 1.5%). Conclusions Modern immunosuppression and Biopsy techniques have improved the success of solitary Pancreas transplantations to the point where outcome is now equivalent to that of SPKs.

Related terms

Pancreas Biopsy - 15 days free trial to Access Experts & Abstracts