Pancreas Transplantation

The survival of pancreas transplantation for treatments of patients with type Ⅰ diabetes mellitus has been improved especially in simultaneous pancreas and renal transplantation. Various innovations in immunosuppression, management of the pancreatic and exocrine secretion, recipient selection and HLA matching have been contributed to achieve a reasonable outcome in pancreas transplantation compared with other organ transplantation. Current improved graft survival has stimulated many centers in the world to start pancreas transplantation program. Since the first successful case of simulaneous pancreas and renal transplantation in my department in 1992, total 7 cases of pancreas transplantation was done, in which 2 cases of simultaneous pancreas and kidney transplantation was performed initially followed by 1 case of sequential pancreas transplantation after kidney transplant, 1 case of living donor pancreas transplant and 3 cases of pancreas transplantation alone.The survival of pancreas transplantation for treatments of patients with type Ⅰ diabetes mellitus has been improved especially in simultaneous pancreas and renal transplantation. Various innovations in immunosuppression, management of the pancreatic and exocrine secretion, recipient selection and HLA matching have been contributed to achieve a reasonable outcome in pancreas transplantation compared with other organ transplantation. Current improved graft survival has stimulated many centers in the world to start pancreas transplantation program. Since the first successful case of simulaneous pancreas and renal transplantation in my department in 1992, total 7 cases of pancreas transplantation was done, in which 2 cases of simultaneous pancreas and kidney transplantation was performed initially followed by 1 case of sequential pancreas transplantation after kidney transplant, 1 case of living donor pancreas transplant and 3 cases of pancreas transplantation alone

Analysis of IL-2 Receptor Expression in Heart-Lung Transplanted Mice

Improved graft survival after organ transplantation is relied upon the innumerable studies concerning the immunologic reactions following antigen exposure and the accompanying strategies against rejection response. Cellular immunity is known to act as a major role in organ transplantation. We performed heart-lung transplantation in mice in order to define cellular immune reactions. For that purpose we analysed the functional role of the immune cells by the cellular cytotoxicity and phenotypic reactions by the IL-2 receptor(R) positive immune cells in the spleen as well as in the graft. ·Mean graft survival after the allogenic heart-lung transplantation in mice(BALB/C to CBA) was 8.5±2.5 days. ·Splenocyte cytotoxicity was the highest on the postoperative day 6 and then decreased abruptly to even lower than that of control mouse. ·Immunohistochemical analysis of spleen harvested consecutively during the postoperative period showed that proportion of IL-2R positive lymphocyte was around 20% in white pulp and scarce in red pulp illustrating nonspecific pattern regardless of rejection. ·Quantitative assay of IL-2R positive splenocyte showed the peak level on the postoperative day 6. ·IL-2R analysis of transplanted heart showed that IL-2R positive lymphocyte infiltated the heart progressively from the epicardium toward the endocardium with the maximal cellular infiltrate progressively from the epicardium toward the endocardium with the maximal cellular infiltrate on the postoperative day 4. These results illustrate that cellular cytotoxicity and expression of IL-2R positive cells have the consistent finding in terms of roles and diagnostic aid graft rejection following heart-lung transplantation in mice.Improved graft survival after organ transplantation is relied upon the innumerable studies concerning the immunologic reactions following antigen exposure and the accompanying strategies against rejection response. Cellular immunity is known to act as a major role in organ transplantation. We performed heart-lung transplantation in mice in order to define cellular immune reactions. For that purpose we analysed the functional role of the immune cells by the cellular cytotoxicity and phenotypic reactions by the IL-2 receptor(R) positive immune cells in the spleen as well as in the graft. ·Mean graft survival after the allogenic heart-lung transplantation in mice(BALB/C to CBA) was 8.5±2.5 days. ·Splenocyte cytotoxicity was the highest on the postoperative day 6 and then decreased abruptly to even lower than that of control mouse. ·Immunohistochemical analysis of spleen harvested consecutively during the postoperative period showed that proportion of IL-2R positive lymphocyte was around 20% in white pulp and scarce in red pulp illustrating nonspecific pattern regardless of rejection. ·Quantitative assay of IL-2R positive splenocyte showed the peak level on the postoperative day 6. ·IL-2R analysis of transplanted heart showed that IL-2R positive lymphocyte infiltated the heart progressively from the epicardium toward the endocardium with the maximal cellular infiltrate progressively from the epicardium toward the endocardium with the maximal cellular infiltrate on the postoperative day 4. These results illustrate that cellular cytotoxicity and expression of IL-2R positive cells have the consistent finding in terms of roles and diagnostic aid graft rejection following heart-lung transplantation in mice

Differences of Self-Esteem, Hopes, Concerns and Stressors following Kidney Transplantation of Kidney recipients

This study attempted to examine the differences of self - esteem, hopes, concerns and total stress scores of 110 kidney recipients in before(N=32) and fellowing kidney transplantation [1 to 6 months(N=29), 6 to 12 months(N=23), 12 to 36 months(N=26)] and utilizing severity rating scale of 44 potential stressors on a 5-point scale of 110 kidney recipients in before(N=32) and following kidney transplantation operation [1 to 6 months(N=29), 6 to 12 months(N=23), 12 to 24 months(N=15) and 24 to 36 months(N=11)]. On scores of hopes and total stress, pretransplant group exhibited significantly higher scores than three posttransplant recipient groups. But, it was found that there was no significant differences among four transplant kidney recipient groups on the scores of self - esteem and concerns. In the pretransplant group, craving for foods was identified as the most stressful event, on the contrary, changes in friends was identified as the lowest stressful events. In the 1 to 6 months posttransplant group, side effect of medications was identified as the most stressful event, however, loss of contact with dialysis patients was identified as the lowest stressful event. In the 6 to 12 months posttransplant group, cost of medication, changes in body appearance were identified as the most stressful event, on the other hand, managing of medications at home was identified as the lowest stressful event. In the 12 to 24 months posttransplant group, cost of medication and insurance coverage were identified as the most stressful event, but possibility of dying and competence of nursing staff were identified as the lowest stressful event. In the 24 to 36 months posttransplant group, changes of body appearance was identified as the most stressful event, on the contrary, possibility of infection was identified as the lowest stressful event. Insurance coverage was a continuing concern throughout posttransplant period.This study attempted to examine the differences of self - esteem, hopes, concerns and total stress scores of 110 kidney recipients in before(N=32) and fellowing kidney transplantation [1 to 6 months(N=29), 6 to 12 months(N=23), 12 to 36 months(N=26)] and utilizing severity rating scale of 44 potential stressors on a 5-point scale of 110 kidney recipients in before(N=32) and following kidney transplantation operation [1 to 6 months(N=29), 6 to 12 months(N=23), 12 to 24 months(N=15) and 24 to 36 months(N=11)]. On scores of hopes and total stress, pretransplant group exhibited significantly higher scores than three posttransplant recipient groups. But, it was found that there was no significant differences among four transplant kidney recipient groups on the scores of self - esteem and concerns. In the pretransplant group, craving for foods was identified as the most stressful event, on the contrary, changes in friends was identified as the lowest stressful events. In the 1 to 6 months posttransplant group, side effect of medications was identified as the most stressful event, however, loss of contact with dialysis patients was identified as the lowest stressful event. In the 6 to 12 months posttransplant group, cost of medication, changes in body appearance were identified as the most stressful event, on the other hand, managing of medications at home was identified as the lowest stressful event. In the 12 to 24 months posttransplant group, cost of medication and insurance coverage were identified as the most stressful event, but possibility of dying and competence of nursing staff were identified as the lowest stressful event. In the 24 to 36 months posttransplant group, changes of body appearance was identified as the most stressful event, on the contrary, possibility of infection was identified as the lowest stressful event. Insurance coverage was a continuing concern throughout posttransplant period

Nonfunctioning islet tumor of pancreas

Nonfunctioning pancreatic endocrine tumor is a rare disease without showing any specific clinical manifestations. Indolent growth of this tumor has a prognosis in between functioning endosrine tumor of pancreas and exocrine adenocarcinoma. We experienced a nonfunctioning pancreatic islet tumor in 59 year old male patient. The tumor in the body of pancreas was clinically silent and had no hormonal activity in immunohistochemical stainingNonfunctioning pancreatic endocrine tumor is a rare disease without showing any specific clinical manifestations. Indolent growth of this tumor has a prognosis in between functioning endosrine tumor of pancreas and exocrine adenocarcinoma. We experienced a nonfunctioning pancreatic islet tumor in 59 year old male patient. The tumor in the body of pancreas was clinically silent and had no hormonal activity in immunohistochemical stainin

Clinical Analysis of Distal Bile Duct Cancer

Primary cancer of the extrahepatic bile duct is classified according to its anatomical location as upper, middle, and distal. In general, among them distal bile duct cancer has the best prognosis due to the highest resectability rate. Yet, the only lesion that is expected to be cured is limited to the early bile duct cancer. Therefore, earlier recognition and treatment with resection will be necessary to increase survival rates. A retrospective analysis was conducted in 17 patients with distal bile duct cancer managed at our hospital during 2 year-period(1989. 6∼1991. 5). The results were follows ; 1) The incidence of the distral bile duct cancer among the extrahepatic bile duct cancers and among the periampullary cancers was 44.7% and 37.0%, respectively. 2) The most common age group was in the 7th decade and male to female ratio was 3.25 : 1. 3) The most common clinical manifestation was jaundice and there were 5 patients who showed the symptoms and signs of acute cholangitis. 4) Among the laboratory findings, almost all patients showed abnormal liver function, especially in SGOT, SGPT, alkaline phophatase, and total bilirubin. 5) By the use of diagnostic tools, the preoperative diagnosis were made in 15 patients (88.2%). 6) As for the operative treatment, we performed Whipple procedure in 13 and total pancreatectomy in 1 with 82.4% of the resectability rate. 7) Histopathologically, most of the lesions were infiltrative type(88.2%) and diagnosed as adenocarcinoma(93.8%). 8) According to the TNM staging, AJCC, 1988, stage Ⅳ lesions were most common(47.0%). 9) There were 2 cases of postoperative death(mortality rate : 11.8%), one was following Whipple procedure-stage ⅣA and the other following biopsy only-stage ⅣB. Accordingly, operative mortality after resection was 7.1% and 33.3% in non-resected group. 10) In our cases, the long-term results. Nevertheless, there were 4 cases of death with their mean survival time of 11.4 months(stage Ⅲ-14 months, stage ⅣA-8.8 months).Primary cancer of the extrahepatic bile duct is classified according to its anatomical location as upper, middle, and distal. In general, among them distal bile duct cancer has the best prognosis due to the highest resectability rate. Yet, the only lesion that is expected to be cured is limited to the early bile duct cancer. Therefore, earlier recognition and treatment with resection will be necessary to increase survival rates. A retrospective analysis was conducted in 17 patients with distal bile duct cancer managed at our hospital during 2 year-period(1989. 6∼1991. 5). The results were follows ; 1) The incidence of the distral bile duct cancer among the extrahepatic bile duct cancers and among the periampullary cancers was 44.7% and 37.0%, respectively. 2) The most common age group was in the 7th decade and male to female ratio was 3.25 : 1. 3) The most common clinical manifestation was jaundice and there were 5 patients who showed the symptoms and signs of acute cholangitis. 4) Among the laboratory findings, almost all patients showed abnormal liver function, especially in SGOT, SGPT, alkaline phophatase, and total bilirubin. 5) By the use of diagnostic tools, the preoperative diagnosis were made in 15 patients (88.2%). 6) As for the operative treatment, we performed Whipple procedure in 13 and total pancreatectomy in 1 with 82.4% of the resectability rate. 7) Histopathologically, most of the lesions were infiltrative type(88.2%) and diagnosed as adenocarcinoma(93.8%). 8) According to the TNM staging, AJCC, 1988, stage Ⅳ lesions were most common(47.0%). 9) There were 2 cases of postoperative death(mortality rate : 11.8%), one was following Whipple procedure-stage ⅣA and the other following biopsy only-stage ⅣB. Accordingly, operative mortality after resection was 7.1% and 33.3% in non-resected group. 10) In our cases, the long-term results. Nevertheless, there were 4 cases of death with their mean survival time of 11.4 months(stage Ⅲ-14 months, stage ⅣA-8.8 months)

Islet isograft transplantation improves insulin sensitivity in a murine model of type 2 diabetes

Purpose Type 2 diabetes develops in the presence of chronic overnutrition and genetic susceptibility, and causes insulin resistance and relative insulin deficiency. We hypothesized that islet transplantation can improve insulin sensitivity by modifying the mediators of insulin sensitivity in the pancreas, liver, muscle, and adipose tissues. Methods Eight-week-old male mice were used as both recipients and donors in this study. To induce type 2 diabetes with partial beta-cell failure, the mice were fed a high-fat diet for 4 weeks and then injected with low-dose streptozotocin. Approximately 400 islet cells from a donor mouse were injected into the renal capsule of a recipient mouse for islet transplantation. After 6 weeks following transplantation, the mediators of insulin sensitivity in the pancreas, liver, muscle, and adipose tissues were quantitatively compared between islet-transplanted and non-transplanted groups. Results Intravenous glucose tolerance test showed that whereas the non-transplanted mice failed to show notable reductions in the glucose level, the islet-transplanted mice showed significant reductions in the serum glucose level to similar to 200 mg/dL at 6 weeks after islet transplantation. The islet-transplanted mice showed significantly higher Matsuda index and significantly lower HOMA-IR than did the non-transplanted mice, thus signifying improved insulin sensitivity. Conclusions Islet transplantation resulted in improvements in multiple indices of insulin sensitivity in a murine model of type 2 diabetes. Islet transplantation may be utilized to improve insulin sensitivity in patients with type 2 diabetes

Lack of Improvement in Insulin Sensitivity After Pancreas Transplantation in Recipients With a High Level of Calcineurin Inhibitors

Objectives This study aimed to assess posttransplant changes in insulin sensitivity and beta-cell function of pancreas transplant recipients according to the type of diabetes mellitus (DM) and the pretransplant insulin sensitivity measured by the Matsuda Index (MI). Methods We analyzed 60 patients who underwent pancreas transplantation and oral glucose tolerance test pretransplant and at 1 month posttransplant. Results At 1 month posttransplant, insulin sensitivity did not show significant improvement; particularly, the MI was significantly lower after transplant in recipients with type 1 DM (T1DM) and those with pretransplant MI of 5 or greater. beta-cell function was significantly improved after transplant in all recipients regardless of the type of DM and pretransplant MI values. Glucose control was significantly improved in recipients with T1DM and in all recipients regardless of the pretransplant MI values. Additional oral glucose tolerance test at 1 year posttransplant revealed that insulin sensitivity remained unimproved and beta-cell function was higher compared with pretransplant. Glucose control had partially reverted to pretransplant levels in recipients with T1DM and those with pretransplant MI of 5 or greater. Conclusions Unlike beta-cell function and glucose control, insulin sensitivity did not significantly improve until posttransplant 1 year after pancreas transplantation regardless of the type of DM or the degree of pretransplant insulin sensitivity