Aref A, Zayan T, Pararajasingam R, Sharma A, Halawa A. Pancreatic transplantation: Brief review of the current evidence. World J Transplant 2019; 9(4): 81-93 [PMID: 31523630 DOI: 10.5500/wjt.v9.i4.81]
Corresponding Author of This Article
Ahmed Halawa, FRCS (Gen Surg), FRSC, MD, MSc, Surgeon, Department of Transplantation Surgery, Sheffield Teaching Hospitals, Herries Road, Sheffield S5 7AU, United Kingdom. ahmed.halawa@sth.nhs.uk
Research Domain of This Article
Transplantation
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Aug 26, 2019; 9(4): 81-93 Published online Aug 26, 2019. doi: 10.5500/wjt.v9.i4.81
Pancreatic transplantation: Brief review of the current evidence
Ahmed Aref, Tariq Zayan, Ravi Pararajasingam, Ajay Sharma, Ahmed Halawa
Ahmed Aref, Tariq Zayan, Department of Nephrology, Sur Hospital, Sur 411, Oman
Ahmed Aref, Tariq Zayan, Ravi Pararajasingam, Ajay Sharma, Ahmed Halawa, Faculty of Health and Science, Institute of Learning and Teaching, University of Liverpool, Liverpool L69 3GB, United Kingdom
Ravi Pararajasingam, Department of Transplantation, Sheffield Teaching Hospitals, Sheffield S5 7AU, United Kingdom
Ajay Sharma, Renal Medicine, Royal Liverpool University Hospitals, Liverpool L7 8XP, United Kingdom
Ahmed Halawa, Department of Transplantation Surgery, Sheffield Teaching Hospitals, Sheffield S5 7AU, United Kingdom
Author contributions: Aref A contributes by designing the work, data collection, writing the manuscript; Zayan T contributes to data collection and organisation of scientific material; Sharma A and Pararajasingam R reviewed and edited the manuscript; Halawa A contributes by choosing the topic of our work, providing expert opinion for writing our work and final editing of the manuscript.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other co-authors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ahmed Halawa, FRCS (Gen Surg), FRSC, MD, MSc, Surgeon, Department of Transplantation Surgery, Sheffield Teaching Hospitals, Herries Road, Sheffield S5 7AU, United Kingdom. ahmed.halawa@sth.nhs.uk
Telephone: +44-7787-542128Fax: +44-1142-714604
Received: February 21, 2019 Peer-review started: February 22, 2019 First decision: April 16, 2019 Revised: April 23, 2019 Accepted: July 29, 2019 Article in press: July 30, 2019 Published online: August 26, 2019 Processing time: 180 Days and 10.9 Hours
Abstract
Kidney transplantation is the treatment of choice for management of end-stage renal disease. However, in diabetic patients, the underlying metabolic disturbance will persist and even may get worse after isolated kidney transplantation. Pancreatic transplantation in humans was first introduced in 1966. The initial outcome was disappointing. However, this was changed after the improvement of surgical techniques together with better patient selection and the availability of potent and better-tolerated immune-suppression like cyclosporine and induction antibodies. Combined kidney and pancreas transplantation will not only solve the problem of organ failure, but it will also stabilise or even reverse the metabolic complications of diabetes. Combined kidney and pancreas transplantation have the best long term outcome in diabetic cases with renal failure. Nevertheless, at the cost of an initial increase in morbidity and risk of mortality. Other transplantation options include pancreas after kidney transplantation and islet cell transplantation. We aim by this work to explore various options which can be offered to a diabetic patient with advanced chronic kidney disease. Our work will provide a simplified, yet up-to-date information regarding the different management options for those diabetic chronic kidney failure patients.
Core tip: Kidney transplantation is the treatment of choice for end-stage renal disease. Combined kidney-pancreas transplantation provides the patients with the highest long term survival. There are different surgical approaches for combined kidney-pancreas transplantation with recognised advantages and limitations of each technique. Islet cell transplantation is a minimally invasive treatment option but carries a risk of sensitisation to a wide range of human leukocyte antigen antigens.
