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Pancreas transplant rejection

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https://www.readbyqxmd.com/read/28777488/discordant-rejection-in-simultaneous-pancreas-and-kidney-transplantation-true-discordance-or-analysis-artefact
#1
Michela Assalino, Karine Hadaya, Axel Andres, Thierry Berney
The article by Parajuli et al published in this issue of Transplant International is the latest, and perhaps the most convincing in a relatively small body of literature, to suggest that in a situation of simultaneous pancreas-kidney transplantation (SPK), in which both organs are from the same donor, one organ may be undergoing acute rejection independently from the other (1). The organ hierarchy in immunogeneicity and susceptibility to rejection is a long known biological phenomenon, with the liver at one end of the spectrum and the intestine the other...
August 4, 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/28738239/delayed-graft-duodenal-perforation-due-to-impacted-food-five-years-after-simultaneous-pancreas-kidney-transplantation-a-case-report
#2
Taizo Sakata, Hideki Katagiri, Tadao Kubota, Takashi Sakamoto, Kentaro Yoshikawa, Alan Kawarai Lefor, Cheol Woong Jung, Toru Kojima
INTRODUCTION: Pancreas transplantation is the best treatment option in selected patients with type 1 diabetes mellitus. Here we report a patient with a nonmarginal duodenal perforation five years after a simultaneous pancreas-living donor kidney transplantation (SPLKT). PRESENTATION OF CASE: A 31-year old male who underwent SPLKT five years previously presented with severe abdominal pain. He had a marginal duodenal perforation four years later, treated by primary closure and drainage...
2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28726153/immunological-issues-after-stem-cell-based-%C3%AE-cell-replacement
#3
REVIEW
Valeria Sordi, Silvia Pellegrini, Lorenzo Piemonti
PURPOSE OF REVIEW: Islet and pancreas transplantation prove that β cell replacement can cure the glycemic derangements in type 1 diabetes (T1D). Induced pluripotent stem cells (iPSCs) can differentiate into functional insulin-producing cells, able to restore normoglycemia in diabetic animal models. iPSCs in particular can be derived from the somatic cells of a person with T1D. This review aims to clarify if it is possible to transplant autologous iPSC-derived β cells without immunosuppression or which are the alternative approaches...
September 2017: Current Diabetes Reports
https://www.readbyqxmd.com/read/28719059/pancreatic-allograft-thrombosis-suggestion-for-a-ct-grading-system-and-management-algorithm
#4
Abdul Hakeem, John Chen, Satheesh Iype, Menna Clatworthy, Christopher Watson, Edmund M Godfrey, Sara Upponi, Kourosh Saeb-Parsy
Pancreatic allograft thrombosis (PAT) remains the leading cause of non-immunological graft failure. Herein we propose a new CT grading system of PAT to identify risk factors for allograft loss and outline a management algorithm by retrospective review of consecutive pancreatic transplants between 2009-2014. Triple-phase CT scans were graded independently by two radiologists as; Grade 0 - no thrombosis, Grade 1 - peripheral thrombosis, Grade 2 - intermediate non-occlusive thrombosis and Grade 3 - central occlusive thrombosis...
July 18, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28696022/outcomes-in-pancreas-transplantation-with-exocrine-drainage-through-a-duodenoduodenostomy-versus-duodenojejunostomy
#5
J P Lindahl, R Horneland, E Nordheim, A Hartmann, E M Aandahl, K Grzyb, H Haugaa, G Kjøsen, A Åsberg, T Jenssen
Until recently, pancreas transplantation has mostly been performed with exocrine drainage via duodenojejunostomy (DJ). Since 2012, DJ was substituted with duodenoduodenostomy (DD) in our hospital, allowing endoscopic access for biopsies. This study assessed safety profiles with DD versus DJ procedures, and clinical outcomes with the DD technique in pancreas transplantation. DD patients (n=117; 62 simultaneous pancreas and kidney [SPKDD ] and 55 pancreas transplantation alone [PTADD ] with median follow-up 2...
July 11, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28672081/concurrent-biopsies-of-both-grafts-in-recipients-of-simultaneous-pancreas-and-kidney-demonstrate-high-rates-of-discordance-for-rejection-as-well-as-discordance-in-type-of-rejection-a-retrospective-study
#6
Sandesh Parajuli, Emre Arpali, Brad C Astor, Arjang Djamali, Fahad Aziz, Robert R Redfield, Hans W Sollinger, Dixon B Kaufman, Jon Odorico, Didier A Mandelbrot
It is commonly assumed that in simultaneous pancreas and kidney (SPK) recipients, rejection of the two organs is concordant. As a result, concurrent biopsies of both organs are rarely performed and there are limited histological data on how often rejection is in fact discordant. We reviewed all SPK recipients transplanted at the University of Wisconsin between January 01, 2001, and December 31, 2016, that underwent biopsy of both organs. We included all patients whose biopsies were within 30 days. If patients were treated for rejection between biopsies, they were excluded if the biopsies were more than 4 days apart...
July 3, 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/28639386/development-of-immune-response-to-tissue-restricted-self-antigens-in-simultaneous-kidney-pancreas-transplant-recipients-with-acute-rejection
#7
Muthukumar Gunasekaran, Neeta Vachharajani, Joseph P Gaut, Thin Thin Maw, Rowena Delos Santos, Surendra Shenoy, William C Chapman, Jason Wellen, Thalachallour Mohanakumar
Simultaneous kidney-pancreas transplantation (SKP Tx) is a treatment for end-stage kidney disease secondary to diabetes mellitus. We investigated the role of immune responses to donor human leukocyte antigens (HLA) and tissue-restricted kidney and pancreas self-antigens (KSAgs and PSAgs, respectively) in SKP Tx recipients (SKP TxRs). Sera collected from 39 SKP TxRs were used to determine de novo Abs specific for KSAgs (collagen-IV, Col-IV; fibronectin, FN) and PSAgs (insulin, islet cells, glutamic acid decarboxylase, and pancreas-associated protein-1) by ELISA...
June 21, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28540837/enterovesical-fistula-after-enteric-conversion-of-a-bladder-drained-pancreatic-allograft-a-case-report
#8
Clifford Akateh, Amer Rajab, Mitchell Henry, Ashraf El-Hinnawi
Since the inception of pancreas transplant as a treatment for type 1 diabetes mellitus, there has been considerable debate about the best way to manage exocrine secretions and monitor patients for graft rejection. For patients who undergo bladder exocrine drainage of a pancreatic allograft, a bladder-to-enteric drainage conversion can serve as a rescue procedure in case of anastomotic leaks or other complications. However, this procedure is associated with its own complications, including a rarely described enterovesical fistula...
May 22, 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28532102/islet-encapsulated-implantable-composite-hollow-fiber-membrane-based-device-a-bioartificial-pancreas
#9
Rohit S Teotia, Sachin Kadam, Atul Kumar Singh, Surendra Kumar Verma, Ashutosh Bahulekar, Sujata Kanetkar, Jayesh Bellare
Islets from xeno-sources and islet like clusters derived from autologus stem cells have emerged as alternatives to cadaveric pancreas used for treatment of type 1 diabetes. However, the immuno-isolation of these islets from the host immune system suffers from the issue of biocompatibility and hypoxia. To overcome the issues of immunobarrier biocompatibility, we developed a Polysulfone (Psf)/TPGS composite hollow fiber membrane (HFM) using a hollow fiber spinning pilot plant specially developed for this purpose...
August 1, 2017: Materials Science & Engineering. C, Materials for Biological Applications
https://www.readbyqxmd.com/read/28509373/bk-viremia-surveillance-and-outcomes-in-simultaneous-pancreas-kidney-transplant-recipients
#10
Scott G Westphal, Elizabeth R Lyden, Eric D Langewisch, Clifford D Miles
BACKGROUND: While screening for asymptomatic BK viremia (BKV) has been well studied in isolated kidney transplant recipients, there is a paucity of published outcomes in simultaneous pancreas-kidney (SPK) transplant recipients who underwent BKV screening followed by pre-emptive reduction in immunosuppression. METHODS: This is a single-center, retrospective review of 31 consecutive SPK recipients who were transplanted over a 5-year period following the initiation of a serum BKV screening protocol...
May 16, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28500781/pregnancy-outcomes-in-simultaneous-pancreas-and-kidney-transplant-recipients-a-national-french-survey-study
#11
Gabrielle Normand, Flora Brunner, Lionel Badet, Fanny Buron, Marielle Catton, Jérôme Massardier, Laure Esposito, Philippe Grimbert, Georges Mourad, Jean E Serre, Sophie Caillard, Georges Karam, Diego Cantarovich, Emmanuel Morelon, Olivier Thaunat
Simultaneous pancreas and kidney transplantation (SPK) is currently the best therapeutic option for patients with type 1 diabetes and terminal renal failure. Renal transplantation restores fertility enabling women to pursue pregnancies. However, scarcity of available data on pregnancy outcomes in SPK impedes fair medical counseling. Medical files of all pregnancies that lasted ≥3 months among recipients of functional SPK performed between 1990 and 2015 in France were retrospectively analyzed. Twenty-six pregnancies in 22 SPK recipients were identified...
September 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/28492724/human-islet-xenotransplantation-in-rodents-a-literature-review-of-experimental-model-trends
#12
Leandro Ryuchi Iuamoto, André Silva Franco, Fábio Yuji Suguita, Felipe Futema Essu, Lucas Torres Oliveira, Juliana Mika Kato, Matheus Belloni Torsani, Alberto Meyer, Wellington Andraus, Eleazar Chaib, Luiz Augusto Carneiro D'Albuquerque
Among the innovations for the treatment of type 1 diabetes, islet transplantation is a less invasive method of treatment, although it is still in development. One of the greatest barriers to this technique is the low number of pancreas donors and the low number of pancreases that are available for transplantation. Rodent models have been chosen in most studies of islet rejection and type 1 diabetes prevention to evaluate the quality and function of isolated human islets and to identify alternative solutions to the problem of islet scarcity...
April 2017: Clinics
https://www.readbyqxmd.com/read/28489277/pancreas-after-islet-transplantation-in-nonuremic-type-1-diabetes-a-strategy-for-restoring-durable-insulin-independence
#13
S A Wisel, J M Gardner, G R Roll, J Harbell, C E Freise, S Feng, S M Kang, R Hirose, D B Kaufman, A M Posselt, P G Stock
Islet transplantation offers a minimally invasive approach for β cell replacement in diabetic patients with hypoglycemic unawareness. Attempts at insulin independence may require multiple islet reinfusions from distinct donors, increasing the risk of allogeneic sensitization. Currently, solid organ pancreas transplant is the only remaining surgical option following failed islet transplantation in the United States; however, the immunologic impact of repeated exposure to donor antigens on subsequent pancreas transplantation is unclear...
May 10, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28467694/durable-control-of-autoimmune-diabetes-in-mice-achieved-by-intraperitoneal-transplantation-of-neo-islets-three-dimensional-aggregates-of-allogeneic-islet-and-mesenchymal-stem-cells
#14
Christof Westenfelder, Anna Gooch, Zhuma Hu, Jon Ahlstrom, Ping Zhang
Novel interventions that reestablish endogenous insulin secretion and thereby halt progressive end-organ damage and prolong survival of patients with autoimmune Type 1 diabetes mellitus (T1DM) are urgently needed. While this is currently accomplished with allogeneic pancreas or islet transplants, their utility is significantly limited by both the scarcity of organ donors and life-long need for often-toxic antirejection drugs. Coadministering islets with bone marrow-derived mesenchymal stem cells (MSCs) that exert robust immune-modulating, anti-inflammatory, anti-apoptotic, and angiogenic actions, improves intrahepatic islet survival and function...
May 3, 2017: Stem Cells Translational Medicine
https://www.readbyqxmd.com/read/28393434/multivisceral-transplantation-for-abdominal-tumors-in-children-a-single-center-experience-and-review-of-the-literature
#15
Eliza Lee, Nicole Hodgkinson, Rima Fawaz, Khashayar Vakili, Heung Bae Kim
Standard management of intra-abdominal pediatric solid tumors requires complete resection. However, tumors with multiple organ and vascular involvement present a unique surgical challenge. We conducted a retrospective chart review of four patients, aged 2-14 years, undergoing MVT for intra-abdominal tumors with significant involvement of the visceral arteries and/or portomesenteric venous system at our institution. Indications for MVT included hepatocellular carcinoma, inflammatory myofibroblastic tumor, and two cases of hepatoblastoma...
August 2017: Pediatric Transplantation
https://www.readbyqxmd.com/read/28349124/alemtuzumab-induction-and-delayed-acute-rejection-in-steroid-free-simultaneous-pancreas-kidney-transplant-recipients
#16
Jonna R Bank, Sebastiaan Heidt, Dirk Jan A R Moes, Dave L Roelen, Marko J K Mallat, Paul J M van der Boog, Manon Vergunst, Cornelia M Jol-van der Zijde, Robbert G M Bredius, Andries E Braat, Jan Ringers, Maarten J D van Tol, Frans H J Claas, Marlies E J Reinders, Johannes W de Fijter
BACKGROUND: The optimal immunosuppressive regimen in simultaneous pancreas-kidney transplant (SPKT) recipients that prevents acute rejection episodes (AREs) and allows optimal outcome remains elusive. METHODS: This cohort study assessed incidence and time to AREs in 73 consecutive SPKT recipients receiving alemtuzumab induction and steroid-free maintenance with tacrolimus and mycophenolate mofetil. A cohort with single high-dose antithymocyte globulin (ATG; n = 85) and triple therapy served as controls...
January 2017: Transplantation Direct
https://www.readbyqxmd.com/read/28332959/de-novo-donor-specific-antibody-formation-in-tacrolimus-based-mycophenolate-versus-mammalian-target-of-rapamycin-immunosuppressive-regimens
#17
Zain Mithani, Jane Gralla, Oluwafisayo Adebiyi, Patrick Klem, James E Cooper, Alexander C Wiseman
OBJECTIVES: De novo donor-specific antibody formation posttransplant is associated with decreased graft survival. It is not known whether mammalian target of rapamycin inhibitors may be advantageous or detrimental compared with mycophenolate in the prevention of de novo donor-specific antibody formation. MATERIALS AND METHODS: We compared 66 kidney and kidney-pancreas transplant recipients who received tacrolimus, mammalian target of rapamycin inhibitor, and prednisone (group 1; 36 of whom received everolimus and 30 of whom received sirolimus) versus 132 patients who received tacrolimus, mycophenolate, and prednisone (group 2) matched for age, sex, race, and type/timing of transplant from 2007 to 2012...
March 22, 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28267898/laparoscopic-biopsies-in-pancreas-transplantation
#18
P D Uva, J S Odorico, A Giunippero, I C Cabrera, A Gallo, L R Leon, E Minue, F Toniolo, I Gonzalez, E Chuluyan, D H Casadei
As there is no precise laboratory test or imaging study for detection of pancreas allograft rejection, there is increasing interest in obtaining pancreas tissue for diagnosis. Pancreas allograft biopsies are most commonly performed percutaneously, transcystoscopically, or endoscopically, yet pancreas transplant surgeons often lack the skills to perform these types of biopsies. We have performed 160 laparoscopic pancreas biopsies in 95 patients. There were 146 simultaneous kidney-pancreas biopsies and 14 pancreas-only biopsies due to pancreas alone, kidney loss, or extraperitoneal kidney...
August 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28260427/annual-data-for-kidney-transplant-services-in-kuwait-2015
#19
Yahya M Makkeyah, Turki Al-Otaibi, Narayanan Nampoory, Prasad Nair, Mostafa Al-Mousawi, Mahmoud Samhan, Alaa Gawish, Tarek Said, Medhat A Halim, Osama Gheith
OBJECTIVES: Renal transplant services have been provided by the Hamed Al-Essa Organ Transplant Center in Ibn Sina Hospital since 1979 for Kuwaitis and non-Kuwaiti citizens residing in Kuwait. We aimed to monitor the activity and outcome of annual renal transplants in 2015. MATERIALS AND METHODS: Data on transplant patients were collected from hospital records from January 1, 2015, through December 31, 2015, at Ibn Sina Hospital. RESULTS: Eighty-one patients underwent a renal transplant in Kuwait in 2015; 46 patients (56...
February 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28176480/de-novo-thrombotic-microangiopathy-following-simultaneous-pancreas-and-kidney-transplantation-managed-with-eculizumab
#20
REVIEW
Lani Shochet, John Kanellis, Ian Simpson, Joseph Ta, William Mulley
Thrombotic microangiopathy (TMA) is a well-recognised complication following transplantation, often due to an underlying genetic predisposition, medications or rejection. The use of eculizumab in these settings has been previously described, but its role still remains to be clarified. A 45-year-old man, with a history of type 1 diabetes mellitus and subsequent end-stage kidney failure, presented for a simultaneous pancreas-kidney transplant. Immunologically, he was well matched with the donor, and he received standard induction immunosuppression including tacrolimus...
February 2017: Nephrology
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