Combined en-bloc liver-pancreas transplantation in patients with liver cirrhosis and insulin-dependent type 2 diabetes mellitus.

Abstract

We report about our experience with combined en-bloc liver-pancreas transplantation in 14 patients with liver cirrhosis and insulin dependent type 2 diabetes mellitus. Exocrine drainage was achieved by duodeno-duodenostomy. Median posttransplant follow-up is currently 92.5 months. All patients were rendered independent from insulin therapy shortly after transplantation. Levels of glycosylated hemoglobin normalized in all recipients. Mean fasting C-peptide values increased from pretransplant 7.0+/-1.7 ng/mL to 10.5+/-2.9 ng/mL 3 months posttransplantation (P<0.001). One recipient (7.1%) developed recurrent exogenous insulin dependence 7 years after transplantation. Pancreas allograft rejection was confirmed by endoscopic biopsy of donor duodenum mucosa in two patients (14.3%). Calculated 5- and 7-year survival is currently at 64.3% and 64.3%, respectively. Our results indicate that combined en-bloc liver-pancreas transplantation using duodeno-duodenostomy is technically feasible and leads to excellent long-term control of glucose metabolism in patients with liver cirrhosis and insulin-dependent type 2 diabetes.

• Authors: Arno Kornberg, Bernadett Küpper, Erik Bärthel, Andrea Tannapfel, Ulrich A Müller, Katharina Thrum, Christof Kloos, Gunter Wolf
• Journal: Transplantation (Transplantation) Vol. 87 Issue 4 Pg. 542-5 (Feb 27 2009) ISSN: 1534-6080 [Electronic] United States
• PMID: 19307791 (Publication Type: Journal Article)

Chemical References

• Blood Glucose
• C-Peptide
• Glycated Hemoglobin A
• Immunosuppressive Agents
• Insulin

Topics

• Adult
• Aged
• Anastomosis, Surgical
• Blood Glucose (metabolism)
• C-Peptide (metabolism)
• Diabetes Mellitus, Type 2 (complications, surgery)
• Duodenum (transplantation)
• Female
• Glycated Hemoglobin (analysis)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Insulin (blood)
• Liver Cirrhosis (complications, surgery)
• Liver Transplantation (immunology, methods)
• Male
• Middle Aged
• Pancreas Transplantation (immunology, methods)