First World Consensus Conference on pancreas transplantation: Part II - recommendations.

Funder: Fondazione Pisa, Pisa, Italy; Id: http://dx.doi.org/10.13039/100007368Funder: Tuscany Region, Italy; Id: http://dx.doi.org/10.13039/501100009888Funder: Pisa University Hospital, Pisa, ItalyFunder: University of Pisa, Pisa, Italy; Id: http://dx.doi.org/10.13039/501100007514The First World Consensus Conference on Pancreas Transplantation provided 49 jury deliberations regarding the impact of pancreas transplantation on the treatment of diabetic patients, and 110 experts' recommendations for the practice of pancreas transplantation. The main message from this consensus conference is that both simultaneous pancreas-kidney transplantation (SPK) and pancreas transplantation alone can improve long-term patient survival, and all types of pancreas transplantation dramatically improve the quality of life of recipients. Pancreas transplantation may also improve the course of chronic complications of diabetes, depending on their severity. Therefore, the advantages of pancreas transplantation appear to clearly surpass potential disadvantages. Pancreas after kidney transplantation increases the risk of mortality only in the early period after transplantation, but is associated with improved life expectancy thereafter. Additionally, preemptive SPK, when compared to SPK performed in patients undergoing dialysis, appears to be associated with improved outcomes. Time on dialysis has negative prognostic implications in SPK recipients. Increased long-term survival, improvement in the course of diabetic complications, and amelioration of quality of life justify preferential allocation of kidney grafts to SPK recipients. Audience discussions and live voting are available online at the following URL address: http://mediaeventi.unipi.it/category/1st-world-consensus-conference-of-pancreas-transplantation/246

Etat actuel de la transplantation pancréatique.

Today, combined kidney and pancreas transplantation is the best treatment for patients with type I diabetes and pre-end or end-stage renal disease due to the diabetic nephropathy. Twenty-nine patients underwent that procedure at our Institution. Recent technical modifications--with the use of a whole pancreas graft with urinary drainage of the exocrine secretion in the recipient by performing a pancreatico-duodeno-cystostomy--allow the monitoring of the exocrine secretion which is a pertinent immunological marker for pancreas rejection. In the next future, pancreas alone should be considered safely using the same procedure, in non uremic diabetic recipients in whom extra-renal secondary complications are more serious than the potential side effects of chronic immunosuppression. That type of pancreas transplantation should benefit of the forthcoming immunosuppressive drugs

Cyclosporin A efficacy and toxicity in organ transplantation with special focus on cadaveric renal transplantation.

The pharmacodynamic and pharmacokinetic properties of cyclosporin A are reviewed. Its adverse reactions and posology in allograft transplantation are described according to clinical experience. Preliminary results with the use of cyclosporin A (Cy A) in primary cadaveric renal transplant patients, in comparison to 3 other conventional treatments, are reported in a randomized study of 69 patients: even if graft acute tubular necrosis is more frequent in the Cy A group, this group is the one which reaches the most successful short term renal graft survival