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Pankreastransplantation
Dr. Abidin Geles
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abidin.geles@gmail.com
Pancreastransplantation
Pancreastransplantation is nowadays the only curative treatment for complicated insulin-dependent diabetes to enable insulin independence and to improve diabetes complications as well as quality of life.
Indication for Pancreas transplantation
Diabetes mellitus Typ 1: Autoimmune disease in which pancreas stops producing the hormone insulin.
Inadequate glucose control by medical management alone
Hypoglycemic unawareness and „brittle diabetes", where extremely high or low blood glucose levels are precipiated by minor dietary modifications.
Oft in Kombination mit einer Nierentransplantation durchgeführt, vor allem bei Patienten mit fortgeschrittener diabetischer Nephropathie, die die Nierentransplantation entweder beim gleichen Eingriff oder vorher oder nach der Pankreastransplantation bekommen.
Patienten nach NTx und Diabetes mellitus Typ 1
Contra-indications:
Absolute:
systemic sepsis
malignancy and significant medical co‐morbidity
Relative:
Age (younger than 50)
Severe cardiovascular morbidity
Likehood of noncompliance to therapy
Insulin resistance
Abklärungen
Klinische Untersuchung
Lungen abhören, Ödeme
Diabetische Folgeerkrankungen
Retinopathie
Neuropathie
Polyneuropathie
Herzkreislauferkrankungen
Koronarangiographie
Nephrologisch-urologische Abklärungen
Labor: Krea (Ausgangspunkt)
Infektausschluss
Wichtig bei geplanter Immunsuppression
Immunologische Abklärungen und Gewebetypisierung
Blutgruppe
Psycho-soziale Situation
Compliance
Operation - Pancreas transplant
Intraperitoneal
anastomosis of the donor arterial conduit on to the recipient common iliac artery
donor portal vein onto the recipient inferior vena cava
exocrine secretions are drained into the small bowel
Complications
Vascular complications
acute thrombosis and postoperative hemorrhage
Leaking of exocrine secretions
Acute Rejection
Chronisches Transplantversagen
Komplikation der langzeitimmunsuppressiva
Non-Compliace
Alternativen:
Transplantation von Inselzellen der Pankreas
Outcome and Challenges
1 Jahr Überlebensrate 95%
3 Jahresüberlebensrate 85-94%
5‐year combined kidney‐pancreas graft survival exceeds 70%
islet cell transplantation
Implantation über die Pfortader in die Leber
7 consecutive patients who achieved insulin independence after islet transplantation
60 patients with 1 year insulin independence reported at 80%
1- and 10-year survival rate exceed 95% and 80%
References
1. M.Büchler et al.(2009) Intra‐abdominal transplantation: Principles for the general surgeon. In: General Surgery: Principles and International Practice, Springer, Berlin, Vol. 2 pp: 1947‐1960
Bei Fragen / Feedback bitte E-Mail an abidin.geles@gmail.com
DANKE
Abidin Geles
www.medwissen.ch
