Recipient selection and evaluation for vascularized pancreas transplantation

R. J. Stratta, R. J. Taylor, T. O. Wahl, W. C. Duckworth, T. F. Gallagher, T. F. Knight, J. L. Fischer, T. V. Neumann, S. Miller, Alan Norman Langnas, C. F. Ozaki, J. S. Bynon, Jennifer Lynn Larsen, L. G. Weide, R. S. Cassling, A. J. Taylon, B. W. Shaw

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Abstract

Vascularized pancreas transplantation (PT) is becoming an accepted therapy for selected type I diabetic patients. However, selection and evaluation criteria remain uncertain. In the last 3.5 years, we have interviewed 205 and evaluated 151 diabetic patients for PT. The degree of renal dysfunction (creatinine clearance below 45 ml/min) was used to select patients for combined pancreas-kidney transplantation (PKT) or solitary pancreas transplantation (PTA) (clearance above 70 ml/min). The cardiovascular evaluation (stress thallium study with liberal use of coronary angiography) was used to determine operative risk and provided the other major selection criterion. A total of 104 patients were selected as candidates for PT; 70 have undergone PKT with 98.6% patient survival (1 cardiovascular death), 97.1% kidney graft survival, and 94.2% pancreas graft survival. Thirty-three evaluated patients (24.1%) were not accepted as candidates for PT; 13 have undergone cadaveric kidney transplantation, 5 were placed on the kidney waiting list, and 9 have died. Criteria for PTA include 2 or more diabetic complications or hyperlabile diabetes. Patient (n=12) and pancreas graft survival after PTA is 83.3 and 50%, respectively. Our conclusion is that a multidisciplinary approach was used for recipient selection for PT based on degree of nephropathy, cardiovascular risk, and presence of diabetic complications. Nearly 75% of diabetic patients evaluated were acceptable candidates for PT, Only 4 (3.8%) of these selected patients died while awaiting or undergoing PT, thus optimizing the use of scarce allograft resources and providing evidence for appropriate patient selection.

Original languageEnglish (US)
Pages (from-to)1090-1096
Number of pages7
JournalTransplantation
Volume55
Issue number5
DOIs
StatePublished - Jan 1 1993

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Pancreas Transplantation
Graft Survival
Kidney Transplantation
Patient Selection
Diabetes Complications
Kidney
Pancreas
Waiting Lists
Thallium
Coronary Angiography
Allografts
Creatinine

ASJC Scopus subject areas

  • Transplantation

Cite this

Stratta, R. J., Taylor, R. J., Wahl, T. O., Duckworth, W. C., Gallagher, T. F., Knight, T. F., ... Shaw, B. W. (1993). Recipient selection and evaluation for vascularized pancreas transplantation. Transplantation, 55(5), 1090-1096. https://doi.org/10.1097/00007890-199305000-00030

Recipient selection and evaluation for vascularized pancreas transplantation. / Stratta, R. J.; Taylor, R. J.; Wahl, T. O.; Duckworth, W. C.; Gallagher, T. F.; Knight, T. F.; Fischer, J. L.; Neumann, T. V.; Miller, S.; Langnas, Alan Norman; Ozaki, C. F.; Bynon, J. S.; Larsen, Jennifer Lynn; Weide, L. G.; Cassling, R. S.; Taylon, A. J.; Shaw, B. W.

In: Transplantation, Vol. 55, No. 5, 01.01.1993, p. 1090-1096.

Research output: Contribution to journalArticle

Stratta, RJ, Taylor, RJ, Wahl, TO, Duckworth, WC, Gallagher, TF, Knight, TF, Fischer, JL, Neumann, TV, Miller, S, Langnas, AN, Ozaki, CF, Bynon, JS, Larsen, JL, Weide, LG, Cassling, RS, Taylon, AJ & Shaw, BW 1993, 'Recipient selection and evaluation for vascularized pancreas transplantation', Transplantation, vol. 55, no. 5, pp. 1090-1096. https://doi.org/10.1097/00007890-199305000-00030
Stratta RJ, Taylor RJ, Wahl TO, Duckworth WC, Gallagher TF, Knight TF et al. Recipient selection and evaluation for vascularized pancreas transplantation. Transplantation. 1993 Jan 1;55(5):1090-1096. https://doi.org/10.1097/00007890-199305000-00030
Stratta, R. J. ; Taylor, R. J. ; Wahl, T. O. ; Duckworth, W. C. ; Gallagher, T. F. ; Knight, T. F. ; Fischer, J. L. ; Neumann, T. V. ; Miller, S. ; Langnas, Alan Norman ; Ozaki, C. F. ; Bynon, J. S. ; Larsen, Jennifer Lynn ; Weide, L. G. ; Cassling, R. S. ; Taylon, A. J. ; Shaw, B. W. / Recipient selection and evaluation for vascularized pancreas transplantation. In: Transplantation. 1993 ; Vol. 55, No. 5. pp. 1090-1096.
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abstract = "Vascularized pancreas transplantation (PT) is becoming an accepted therapy for selected type I diabetic patients. However, selection and evaluation criteria remain uncertain. In the last 3.5 years, we have interviewed 205 and evaluated 151 diabetic patients for PT. The degree of renal dysfunction (creatinine clearance below 45 ml/min) was used to select patients for combined pancreas-kidney transplantation (PKT) or solitary pancreas transplantation (PTA) (clearance above 70 ml/min). The cardiovascular evaluation (stress thallium study with liberal use of coronary angiography) was used to determine operative risk and provided the other major selection criterion. A total of 104 patients were selected as candidates for PT; 70 have undergone PKT with 98.6{\%} patient survival (1 cardiovascular death), 97.1{\%} kidney graft survival, and 94.2{\%} pancreas graft survival. Thirty-three evaluated patients (24.1{\%}) were not accepted as candidates for PT; 13 have undergone cadaveric kidney transplantation, 5 were placed on the kidney waiting list, and 9 have died. Criteria for PTA include 2 or more diabetic complications or hyperlabile diabetes. Patient (n=12) and pancreas graft survival after PTA is 83.3 and 50{\%}, respectively. Our conclusion is that a multidisciplinary approach was used for recipient selection for PT based on degree of nephropathy, cardiovascular risk, and presence of diabetic complications. Nearly 75{\%} of diabetic patients evaluated were acceptable candidates for PT, Only 4 (3.8{\%}) of these selected patients died while awaiting or undergoing PT, thus optimizing the use of scarce allograft resources and providing evidence for appropriate patient selection.",
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AU - Knight, T. F.

AU - Fischer, J. L.

AU - Neumann, T. V.

AU - Miller, S.

AU - Langnas, Alan Norman

AU - Ozaki, C. F.

AU - Bynon, J. S.

AU - Larsen, Jennifer Lynn

AU - Weide, L. G.

AU - Cassling, R. S.

AU - Taylon, A. J.

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N2 - Vascularized pancreas transplantation (PT) is becoming an accepted therapy for selected type I diabetic patients. However, selection and evaluation criteria remain uncertain. In the last 3.5 years, we have interviewed 205 and evaluated 151 diabetic patients for PT. The degree of renal dysfunction (creatinine clearance below 45 ml/min) was used to select patients for combined pancreas-kidney transplantation (PKT) or solitary pancreas transplantation (PTA) (clearance above 70 ml/min). The cardiovascular evaluation (stress thallium study with liberal use of coronary angiography) was used to determine operative risk and provided the other major selection criterion. A total of 104 patients were selected as candidates for PT; 70 have undergone PKT with 98.6% patient survival (1 cardiovascular death), 97.1% kidney graft survival, and 94.2% pancreas graft survival. Thirty-three evaluated patients (24.1%) were not accepted as candidates for PT; 13 have undergone cadaveric kidney transplantation, 5 were placed on the kidney waiting list, and 9 have died. Criteria for PTA include 2 or more diabetic complications or hyperlabile diabetes. Patient (n=12) and pancreas graft survival after PTA is 83.3 and 50%, respectively. Our conclusion is that a multidisciplinary approach was used for recipient selection for PT based on degree of nephropathy, cardiovascular risk, and presence of diabetic complications. Nearly 75% of diabetic patients evaluated were acceptable candidates for PT, Only 4 (3.8%) of these selected patients died while awaiting or undergoing PT, thus optimizing the use of scarce allograft resources and providing evidence for appropriate patient selection.

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