Evolution of Pancreas Transplantation At A Single Institution-50+ Years and 2500 Transplants.

IF 7.5 1区 医学 Q1 SURGERY
Annals of surgery Pub Date : 2024-10-01 Epub Date: 2024-06-25 DOI:10.1097/SLA.0000000000006415
Erik B Finger, Abraham J Matar, Ty B Dunn, Abhinav Humar, Angelika C Gruessner, Rainer W G Gruessner, Karthik Ramanathan, Vanessa Humphreville, Arthur J Matas, David E R Sutherland, Raja Kandaswamy
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引用次数: 0

Abstract

Objective: To describe the evolution of pancreas transplantation, including improved outcomes and factors associated with improved outcomes over the past 5 decades.

Background: The world's first successful pancreas transplant was performed in December 1966 at the University of Minnesota. As new modalities for diabetes treatment mature, we must carefully assess the current state of pancreas transplantation to determine its ongoing role in patient care.

Methods: A single-center retrospective review of 2500 pancreas transplants was performed over >50 years in bivariate and multivariable models. Transplants were divided into 6 eras; outcomes are presented for the entire cohort and by era.

Results: All measures of patient and graft survival improved progressively through the 6 transplant eras. The overall death-censored pancreas graft half-lives were >35 years for simultaneous pancreas and kidney (SPK), 7.1 years for pancreas after kidney (PAK), and 3.3 years for pancreas transplants alone (PTA). The 10-year death-censored pancreas graft survival rate in the most recent era was 86.9% for SPK recipients, 58.2% for PAK recipients, and 47.6% for PTA. Overall, graft loss was most influenced by patient survival in SPK transplants, whereas graft loss in PAK and PTA recipients was more often due to graft failures. Predictors of improved pancreas graft survival were primary transplants, bladder drainage of exocrine secretions, younger donor age, and shorter preservation time.

Conclusions: Pancreas outcomes have significantly improved over time through sequential, but overlapping, advances in surgical technique, immunosuppressive protocols, reduced preservation time, and the more recent reduction of immune-mediated graft loss.

一家医疗机构胰腺移植手术的发展历程--50 多年和 2,500 例移植手术。
摘要描述胰腺移植手术的发展历程,包括过去五十年来胰腺移植手术取得的更好疗效以及与疗效改善相关的因素:背景:1966 年 12 月,明尼苏达大学成功进行了世界上首次胰腺移植手术。随着糖尿病治疗新方法的成熟,我们必须仔细评估胰腺移植的现状,以确定其在患者护理中的持续作用:方法:采用双变量和多变量模型对超过 50 年的 2500 例胰腺移植手术进行单中心回顾性研究。移植手术分为六个年代;结果显示了整个队列和不同年代的移植结果:结果:在六个移植年代中,患者和移植物存活率的所有指标都在逐步提高。同时进行胰腺和肾脏移植(SPK)的胰腺移植物总死亡剔除(DC)半衰期大于35年,肾脏移植后进行胰腺移植(PAK)的胰腺移植物半衰期为7.1年,单独进行胰腺移植(PTA)的胰腺移植物半衰期为3.3年。在最近的年代,SPK 受者的 10 年 DC 胰腺移植物存活率为 86.9%,PAK 受者为 58.2%,PTA 为 47.6%。在SPK移植中,移植物总损失受患者存活率的影响最大,而在PAK和PTA受者中,移植物损失更多是由于移植物失败造成的。胰腺移植物存活率提高的预测因素包括初次移植、膀胱引流外分泌分泌物、供体年龄较小、保存时间较短:结论:随着时间的推移,手术技术、免疫抑制方案、保存时间的缩短以及最近免疫介导的移植物损失的减少等方面相继而又重叠地取得了进展,胰腺的预后得到了显著改善。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Annals of surgery
Annals of surgery 医学-外科
CiteScore
14.40
自引率
4.40%
发文量
687
审稿时长
4 months
期刊介绍: The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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