TY - JOUR
T1 - Simultaneous pancreas and kidney transplantation for liver transplant recipients with diabetes and uremia
AU - Tam, Ngalei
AU - Zhang, Chuanzhao
AU - Lin, Jianwei
AU - Wu, Chenglin
AU - Deng, Ronghai
AU - Liao, Bing
AU - Hu, Shuiqing
AU - Wang, Dongping
AU - Zhu, Xiaofeng
AU - Wu, Linwei
AU - He, Xiaoshun
N1 - Funding Information:
We thank Dr. Lafaine Grant from the Clinical centre for liver disease, University of Texas Southwestern Medical Center , who helped us revising the language and writing. This study was supported by the National Natural Science Foundation of China ( No.81102245 and No.81100023 ), Science and Technology Planning Project of Guangdong Province, China ( No.2011B0318000099 ), Medical Scientific Research Foundation of Guangdong Province, China ( No. B2014365 ), Science and Technology Planning Project of Huangpu District, Guangdong Province, China ( No.201329-03 ) and Youth teachers cultivation project of Sun Yat-Sen University ( No. 12ykpy21 ).
Publisher Copyright:
© 2014 Elsevier Masson SAS.
PY - 2015/6/1
Y1 - 2015/6/1
N2 - Background and objectives: Chronic kidney disease (CKD) has become a critical problem due to immunosuppressant related nephrotoxicity in liver transplant (LTx) recipients, especially in patients with pre-transplant risk factors. LTx recipients with uraemia and diabetes have poor prognosis even when treated with dialysis and insulin. Simultaneous pancreas and kidney transplantation (SPK) has been proven to be an effective treatment for patients with diabetic uraemia, but rarely performed in patients after LTx. Two cases of SPK after LTx were performed in our centre and we present our experience here. Patients and methods: Two patients received LTx because of HBV related liver cirrhosis; both of them had pre-transplant diabetes mellitus (DM), which worsened after the administration of immunosuppressive drugs. These two patients suffered from CKD and developed uraemia due to diabetic nephropathy and immunosuppressive drugs induced renal toxicity years after LTx. They relied on dialysis and insulin injection. SPK were performed years after LTx and the clinical data was retrospectively analyzed. Results: SPK was successfully performed in these two patients. Pancreatic fluid drainage was achieved via a side-to-side duodenojejunostomy into the proximal jejunum. No serious surgical complications, including pancreatitis or pancreatic fistula were observed postoperatively. In both cases, kidney and pancreatic grafts were functioning well as evidenced by euglycemia without the need for insulin injections and normal serum-creatinine level 7. days after the operation. One of the patients presented with renal graft impairment 1. week after the operation. FK506 was tapered and rapamycin was used when the renal graft biopsy indicated drug toxicity. The patient's kidney graft function recovered gradually after the adjustment. Both patients have good function of liver, kidney and pancreas grafts during a 60-month and 30-month period of follow up. Conclusions: SPK could serve as an effective option for patients with diabetes and uremia after LTx. Perioperative management, especially the immunosuppressive strategy is crucial to improve the outcome of this procedure.
AB - Background and objectives: Chronic kidney disease (CKD) has become a critical problem due to immunosuppressant related nephrotoxicity in liver transplant (LTx) recipients, especially in patients with pre-transplant risk factors. LTx recipients with uraemia and diabetes have poor prognosis even when treated with dialysis and insulin. Simultaneous pancreas and kidney transplantation (SPK) has been proven to be an effective treatment for patients with diabetic uraemia, but rarely performed in patients after LTx. Two cases of SPK after LTx were performed in our centre and we present our experience here. Patients and methods: Two patients received LTx because of HBV related liver cirrhosis; both of them had pre-transplant diabetes mellitus (DM), which worsened after the administration of immunosuppressive drugs. These two patients suffered from CKD and developed uraemia due to diabetic nephropathy and immunosuppressive drugs induced renal toxicity years after LTx. They relied on dialysis and insulin injection. SPK were performed years after LTx and the clinical data was retrospectively analyzed. Results: SPK was successfully performed in these two patients. Pancreatic fluid drainage was achieved via a side-to-side duodenojejunostomy into the proximal jejunum. No serious surgical complications, including pancreatitis or pancreatic fistula were observed postoperatively. In both cases, kidney and pancreatic grafts were functioning well as evidenced by euglycemia without the need for insulin injections and normal serum-creatinine level 7. days after the operation. One of the patients presented with renal graft impairment 1. week after the operation. FK506 was tapered and rapamycin was used when the renal graft biopsy indicated drug toxicity. The patient's kidney graft function recovered gradually after the adjustment. Both patients have good function of liver, kidney and pancreas grafts during a 60-month and 30-month period of follow up. Conclusions: SPK could serve as an effective option for patients with diabetes and uremia after LTx. Perioperative management, especially the immunosuppressive strategy is crucial to improve the outcome of this procedure.
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U2 - 10.1016/j.clinre.2014.10.001
DO - 10.1016/j.clinre.2014.10.001
M3 - Article
C2 - 25457347
AN - SCOPUS:84930871911
SN - 2210-7401
VL - 39
SP - 399
EP - 404
JO - Clinics and Research in Hepatology and Gastroenterology
JF - Clinics and Research in Hepatology and Gastroenterology
IS - 3
ER -