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Surgical complications observed in simultaneous pancreas-kidney transplantation (SPKTx)—16 years' experience of one centre
Vol. 9, No. 4 2005
experiments elucidating the mechanisms of these processes are needed. Increased knowledge of the intricacies of cell death in this model may help to promote n-3 supplementation as an adjunct to chemotherapy in pancreatic cancer treatment.
269 CYSTS IN THE PANCREAS: HOW GOOD IS COMPUTED TOMOGRAPHY IN DIAGNOSIS? Nabeel M. Shabout, MD, Lisa Hamilton, Robert V. Rege, MD, D. Rohan Jeyarajah, MD, Southwestern Medical School, Dallas, TX There are two main cystic lesions in the pancreas: cystic pancreatic neoplasm (CPN) and pancreatic pseudocyst (PP). Differentiating between these two entities is critical to treatment, as PPs are drained while CPNs are resected. The efficacy of computed tomography (CT) in differentiating CPNs from PP has not been studied and is the purpose of this study. A retrospective review over a five-year period of all patients undergoing pancreatic surgery at a single institution was made. Of these, 32 patients met the inclusion criteria which required preoperative CT and surgical pathology of CPN or PP. The CT interpretation was then compared to the final surgical pathology. Of the 32 patients, 15 had CPN and 17 PP. Of the 15 patients with CPN, 13 were correctly diagnosed with the CT. Of the 17 patients with PP, 2 patients were incorrectly diagnosed by CT as having a CPN. The positive predictive value (PPV) for differentiating between these two entities is 87%. The sensitivity and specificity for CT in diagnosing CPN or PP is 87% and 88%, respectively. Although certain pancreatic lesions are not clearly defined by CT and require other studies, we found computed tomography to be a good method to differentiate between PP and CPN. Specifically, the PPV of CT in differentiating CPN from PP is comparable to published reports of endoscopic ultrasound, another popular diagnostic mode. Our data suggest that the work-up of pancreatic cystic lesions may involve simply a dedicated pancreatic CT.
270 QUALITY OF LIFE AFTER SIMULTANEOUS PANCREAS-KIDNEY TRANSPLANTATION Artur Kwiatkowski, MD, PhD, Grzegorz Michalak, MD, PhD, Jaroslaw Czerwinski, MD, PhD, Andrzej Chmura, MD, PhD, Roman Danielewicz, MD, PhD, Krzysztof Ostrowski, MD, PhD, Wojciech Lisik, MD, PhD, Leszek Adadynski, MD, PhD, Michal Wszola, MD, PhD, Rafal Nosek, MD, Slawomir Fesolowicz, MD, Monika Bieniasz, MD, Tomasz Kasprzyk, MD, Magdalena Durlik, MD, PhD, Janusz Walaszewski, MD, PhD, Wojciech Rowinski, MD, PhD, Warsaw Medical University, Warsaw, Poland Forty-eight simultaneous pancreas-kidney transplantations (SPKTx) were performed in our department between 1988 and 2004. Mean patient age was 34 years mean length of diabetes treatment was 23 years. Prior to SPKTx all patients were on maintenance haemodialysis. It is not well established whether SPKTx improves quality of life of these patients. The aim of this study was to assess the progress of diabetic complication after SPKTx and psycho-social status of these patients. By the end of June 2004, 37 patients were alive. 26 had functioning pancreas and kidney grafts. A questionnaire was sent and received from 26 patients with functioning pancreas grafts. 19 of them consented to take part in the study. We investigated ophtalmological status, presence of macroangiopathy and assessed quality of life. 4 of 19 patients had lower limb amputations after SPKTx. Seven of 19 patients were totally blind, 13 had retinopathy. Nineteen regarded their quality of life as improved compared to pretransplant status. This was mainly attributed to being dialysis and insulin-free. Fourteen
Abstracts
605
of 19 reported controlling their glycaemia regularly which was associated with fear of losing the pancreas graft. Seven of 19 persons returned to work after transplantation. Patients should be qualified to SPKTx before occurrence of diabetic complications, which can make the return to normal life after SPKTx difficult. Patients after SPKTx experience an improvement in the quality of life and, in some cases, return to professional life.
271 SURGICAL COMPLICATIONS OBSERVED IN SIMULTANEOUS PANCREAS-KIDNEY TRANSPLANTATION (SPKTX)—16 YEARS’ EXPERIENCE OF ONE CENTRE Grzegorz Michalak, MD, PhD, Arur Kwiatkowski, MD, PhD, Jaroslaw Czerwinski, MD, PhD, Andrzej Chmura, MD, PhD, Michal Wszola, MD, Rafal Nosek, MD, Krzysztof Ostrowski, MD, Roman Danielwicz, MD, PhD, Wojciech Lisik, MD, PhD, Leszek Adadynski, Maciej Kosieradzki, MD, PhD, Slawomir Fesolowicz, MD, Monika Bieniasz, MD, Tomasz Kasprzyk, MD, Magdalena Durlik, MD, PhD, Janusz Walaszewski, MD, PhD, Wojciech Rowinski, MD, PhD, Warsaw Medical University, Warsaw, Poland Forty-eight SPKTx were performed in our department between 1988 and 2004. Mean patient age was 34 years and length of diabetes treatment, 23 years. All kidney and pancreas recipients were on maintenance hemodialysis therapy prior to SPKTx .The pancreas with duodenal segment and the kidneys were harvested from cadaveric heart beating donors. Cold Ischemia Time in UW solution varied from 4 to 14 hours. 20 patients had duodenal segment sutured to the urinary bladder while the remaining 28 grafts were drained to an isolated ileal loop. Quadruple immunosupression was administrated as well as anticoagulant and antibiotic prophylaxis; 46 patients (46/48, 95%) regained insulin-independence in the immediate postoperative period, and 41 (86%) recipients had immediate function of the kidney graft. Remaining patients underwent ATN during postoperative period. The longest ATN was 18 days. Of 48, 37 (77%) patients are alive (follow-up 6 up to 180 months); 26 of them (70%) with good pancreas function, 33 (89%) with good kidney function. Nineteen patients regarded their quality of life as improved compared to pretransplant status. This was mainly attributed to being dialysis and insulin-free. Fourteen of 19 reported controlling their glycaemia regularly which was associated with fear of losing the pancreas graft. Seven of 19 persons returned to work after transplantation. Four (8.3%) patients lost their kidney graft due to 2 of vascular complication, 2 of rejection. Four pancreas grafts with bladder drainage required conversion to enteric drainage due to persistent urinary infection or urinary fistula. 11 (23%) patients lost their pancreatic grafts within 1 year posttransplant due to the following: vascular complications: 8, septic complications, 1, rejection, 2. 11 patients died within one year after transplantation: 5 of septic complications, 4 of neuroinfection, 1 of pulmonary embolism, and 1 of myocardial infarction. Simultaneous pancreas-kidney transplantation is a successful treatment of diabetic nephropathy, burdened however by the possibility of serious complications.
272 ISLET TRANSPLANTATION UNDER HEPATIC REGENERATION PROMOTES AMELIORATION OF HYPERGLYCEMIA AND INSULIN SECRETION IN STREPTOZOTOCIN-DIABETIC RATS Takeshi Sudo, MD, Eiso Hiyama, MD, Kenichiro Uemura, MD, Yoshiaki Murakami, MD, Yoshio Takesue, MD, Taijiro Sueda, MD, Hiroshima University Hospital, Hiroshima, Japan With the current donor shortage, future success with islet transplantation is incumbent on the ability to use single donor islets. Manipulating
experiments elucidating the mechanisms of these processes are needed. Increased knowledge of the intricacies of cell death in this model may help to promote n-3 supplementation as an adjunct to chemotherapy in pancreatic cancer treatment.
269 CYSTS IN THE PANCREAS: HOW GOOD IS COMPUTED TOMOGRAPHY IN DIAGNOSIS? Nabeel M. Shabout, MD, Lisa Hamilton, Robert V. Rege, MD, D. Rohan Jeyarajah, MD, Southwestern Medical School, Dallas, TX There are two main cystic lesions in the pancreas: cystic pancreatic neoplasm (CPN) and pancreatic pseudocyst (PP). Differentiating between these two entities is critical to treatment, as PPs are drained while CPNs are resected. The efficacy of computed tomography (CT) in differentiating CPNs from PP has not been studied and is the purpose of this study. A retrospective review over a five-year period of all patients undergoing pancreatic surgery at a single institution was made. Of these, 32 patients met the inclusion criteria which required preoperative CT and surgical pathology of CPN or PP. The CT interpretation was then compared to the final surgical pathology. Of the 32 patients, 15 had CPN and 17 PP. Of the 15 patients with CPN, 13 were correctly diagnosed with the CT. Of the 17 patients with PP, 2 patients were incorrectly diagnosed by CT as having a CPN. The positive predictive value (PPV) for differentiating between these two entities is 87%. The sensitivity and specificity for CT in diagnosing CPN or PP is 87% and 88%, respectively. Although certain pancreatic lesions are not clearly defined by CT and require other studies, we found computed tomography to be a good method to differentiate between PP and CPN. Specifically, the PPV of CT in differentiating CPN from PP is comparable to published reports of endoscopic ultrasound, another popular diagnostic mode. Our data suggest that the work-up of pancreatic cystic lesions may involve simply a dedicated pancreatic CT.
270 QUALITY OF LIFE AFTER SIMULTANEOUS PANCREAS-KIDNEY TRANSPLANTATION Artur Kwiatkowski, MD, PhD, Grzegorz Michalak, MD, PhD, Jaroslaw Czerwinski, MD, PhD, Andrzej Chmura, MD, PhD, Roman Danielewicz, MD, PhD, Krzysztof Ostrowski, MD, PhD, Wojciech Lisik, MD, PhD, Leszek Adadynski, MD, PhD, Michal Wszola, MD, PhD, Rafal Nosek, MD, Slawomir Fesolowicz, MD, Monika Bieniasz, MD, Tomasz Kasprzyk, MD, Magdalena Durlik, MD, PhD, Janusz Walaszewski, MD, PhD, Wojciech Rowinski, MD, PhD, Warsaw Medical University, Warsaw, Poland Forty-eight simultaneous pancreas-kidney transplantations (SPKTx) were performed in our department between 1988 and 2004. Mean patient age was 34 years mean length of diabetes treatment was 23 years. Prior to SPKTx all patients were on maintenance haemodialysis. It is not well established whether SPKTx improves quality of life of these patients. The aim of this study was to assess the progress of diabetic complication after SPKTx and psycho-social status of these patients. By the end of June 2004, 37 patients were alive. 26 had functioning pancreas and kidney grafts. A questionnaire was sent and received from 26 patients with functioning pancreas grafts. 19 of them consented to take part in the study. We investigated ophtalmological status, presence of macroangiopathy and assessed quality of life. 4 of 19 patients had lower limb amputations after SPKTx. Seven of 19 patients were totally blind, 13 had retinopathy. Nineteen regarded their quality of life as improved compared to pretransplant status. This was mainly attributed to being dialysis and insulin-free. Fourteen
Abstracts
605
of 19 reported controlling their glycaemia regularly which was associated with fear of losing the pancreas graft. Seven of 19 persons returned to work after transplantation. Patients should be qualified to SPKTx before occurrence of diabetic complications, which can make the return to normal life after SPKTx difficult. Patients after SPKTx experience an improvement in the quality of life and, in some cases, return to professional life.
271 SURGICAL COMPLICATIONS OBSERVED IN SIMULTANEOUS PANCREAS-KIDNEY TRANSPLANTATION (SPKTX)—16 YEARS’ EXPERIENCE OF ONE CENTRE Grzegorz Michalak, MD, PhD, Arur Kwiatkowski, MD, PhD, Jaroslaw Czerwinski, MD, PhD, Andrzej Chmura, MD, PhD, Michal Wszola, MD, Rafal Nosek, MD, Krzysztof Ostrowski, MD, Roman Danielwicz, MD, PhD, Wojciech Lisik, MD, PhD, Leszek Adadynski, Maciej Kosieradzki, MD, PhD, Slawomir Fesolowicz, MD, Monika Bieniasz, MD, Tomasz Kasprzyk, MD, Magdalena Durlik, MD, PhD, Janusz Walaszewski, MD, PhD, Wojciech Rowinski, MD, PhD, Warsaw Medical University, Warsaw, Poland Forty-eight SPKTx were performed in our department between 1988 and 2004. Mean patient age was 34 years and length of diabetes treatment, 23 years. All kidney and pancreas recipients were on maintenance hemodialysis therapy prior to SPKTx .The pancreas with duodenal segment and the kidneys were harvested from cadaveric heart beating donors. Cold Ischemia Time in UW solution varied from 4 to 14 hours. 20 patients had duodenal segment sutured to the urinary bladder while the remaining 28 grafts were drained to an isolated ileal loop. Quadruple immunosupression was administrated as well as anticoagulant and antibiotic prophylaxis; 46 patients (46/48, 95%) regained insulin-independence in the immediate postoperative period, and 41 (86%) recipients had immediate function of the kidney graft. Remaining patients underwent ATN during postoperative period. The longest ATN was 18 days. Of 48, 37 (77%) patients are alive (follow-up 6 up to 180 months); 26 of them (70%) with good pancreas function, 33 (89%) with good kidney function. Nineteen patients regarded their quality of life as improved compared to pretransplant status. This was mainly attributed to being dialysis and insulin-free. Fourteen of 19 reported controlling their glycaemia regularly which was associated with fear of losing the pancreas graft. Seven of 19 persons returned to work after transplantation. Four (8.3%) patients lost their kidney graft due to 2 of vascular complication, 2 of rejection. Four pancreas grafts with bladder drainage required conversion to enteric drainage due to persistent urinary infection or urinary fistula. 11 (23%) patients lost their pancreatic grafts within 1 year posttransplant due to the following: vascular complications: 8, septic complications, 1, rejection, 2. 11 patients died within one year after transplantation: 5 of septic complications, 4 of neuroinfection, 1 of pulmonary embolism, and 1 of myocardial infarction. Simultaneous pancreas-kidney transplantation is a successful treatment of diabetic nephropathy, burdened however by the possibility of serious complications.
272 ISLET TRANSPLANTATION UNDER HEPATIC REGENERATION PROMOTES AMELIORATION OF HYPERGLYCEMIA AND INSULIN SECRETION IN STREPTOZOTOCIN-DIABETIC RATS Takeshi Sudo, MD, Eiso Hiyama, MD, Kenichiro Uemura, MD, Yoshiaki Murakami, MD, Yoshio Takesue, MD, Taijiro Sueda, MD, Hiroshima University Hospital, Hiroshima, Japan With the current donor shortage, future success with islet transplantation is incumbent on the ability to use single donor islets. Manipulating