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Title

EXPANDING THE INDICATIONS OF PANCREAS TRANSPLANTATION ALONE

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 Start Page 133 | End Page 134

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Abstract

 Background: Total pancreatectomy (TP) is associated with post-operative endocrine and exocrine insufficiency, steatohepatitis and potentially liver failure. Insulin therapy, in particular, requires good patient compliance, reduces patients’ quality of life, and may lead to long-term diabetes-associated complications.Objective: We reviewed the literature with regard to the potential option of pancreas transplantation alone (PTA) following TP in patients with chronic pancreatitis or benign tumors.Methods: A Medline search (1958–2013) using the terms [Pancreas Transplantation], [Pancreas Transplantation Alone], [Total Pancreatectomy] and [Morbidity] and [Mortality], [Insulin Therapy] and [Quality of Life] was performed. Current textbooks and congress proceedings were also reviewed.Results: The number of patients undergoing TP for benign or borderline tumors of the pancreas as well as chronic pancreatitis (rarely) is continuously increasing. Despite improvement of exogenous insulin therapy, >50% of these patients experience severe glucose control problems, which cause up to 50% long-term mortality. PTA can cure not only endocrine but also exocrine insufficiency and reduce the associated risk for cardiac, ophthalmic and renal diseases. The 3-year graft and patient survival rates after PTA are up to 73%, and 100%, respectively.Conclusion: PTA following TP in patients with pancreatitis or benign tumors improves the recipient’s quality of life and reduces long-term mortality. This is attributed to elimination of exogenous insulin replacement, frequent daily blood glucose measurements and many of the dietary restrictions imposed after TP. Considering the amount of available organs and potential candidates, PTA can be a treatment option for patients following TP with chronic pancreatitis or benign tumors.

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