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21 May 2009

Pancreas transplantation - evolution of the therapeutic approach based on over 20 years experience

J Szmidt

Ann Transplant 2009; 14(1): 14-14 :: ID: 880244

Abstract

Since the first successful pancreas transplantation in Poland on 4th February
1988 the steady progress of this organ transplantation has been noted. To
the 1st April 2009 224 pancreas transplantations have been performed in five
centers. The number of the transplanted pancreases at particular centers are:
Department of General, Vascular and Transplant Surgery Warsaw Medical
University - 101 transplantations, Department of General and Transplant
Surgery Warsaw Medical University - 58 transplantations, Department of
Gastroenterological Surgery and Transplant Surgery Central Clinical Hospital
MSWiA in Warsaw - 28 transplantations, Department of General, Vascular
and Transplant Surgery Silesian Medical University - 35 transplantations
and Department of General and Transplant Surgery Pomeranian Medical
University - 2 transplantations. Pancreas in Poland is mainly transplanted
simultaneously with kidney. No pancreas transplantation alone has been done
so far in our country. During the last 20 years various surgical technique for
this operation was used. Today almost all pancreas transplantations have
been done with enteric anastomosis and systemic venous drainage however
it could vary depends on transplant center. The several original method was
developed such a four vascular anastomoses technique to prevent vascular
graft thrombosis or duodenal button and sphincterotomy to avoid pancreas
graft oedema and duodenal leakage. Also evolution of immunosuppression
was observed. Now is tendency to introduce induction therapy with depleting
antibodies. Maintenance treatment is based on tacrolimus and mycophenolan mofetil with reduction of steroids. There is a trend to perform transplantation earlier in the pre-dialysis period. Selection of recipients, appropriate surgical technique and immunosuppressive treatment seems to be crucial to improve the results of pancreatic transplantation.

Keywords: Pancreas Transplantation, Organ Transplantation, surgical technique

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358