Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Solitary pancreas transplant not associated with improved survival for patients with diabetes

03.12.2003


Patients with diabetes who received a solitary pancreas transplant appeared to have worse survival than patients on the transplant waiting list who received conventional therapy, according to a study in the December 3 issue of The Journal of the American Medical Association (JAMA).



According to background information in the article, pancreatic transplantation is a therapeutic option for patients with complicated diabetes mellitus. The American Diabetes Association supports the procedure for patients with diabetes who have had, or need, a kidney transplant. In the absence of kidney failure, pancreas transplantation may be considered for patients with diabetes and severe and frequent metabolic instability, i.e., episodes of very low blood glucose levels (hypoglycemia) or high blood glucose levels with buildup of blood acids (ketoacidosis).

According to the article, solitary pancreas transplantation (i.e., pancreas alone or pancreas-after-kidney) for diabetes mellitus remains controversial due to procedure-associated illness and/or death, toxicity of immunosuppression, expense, and unproven effects on the secondary complications of diabetes. Whether transplantation offers a survival advantage over conventional therapies for diabetes is unknown.


Jeffrey M. Venstrom, B.S., of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, Md., and colleagues compared the survival of pancreas transplant recipients in patients with diabetes and preserved kidney function with that of similar patients listed for a pancreas transplant, since they would have conditions similar to those who underwent the transplant procedure.

The study was conducted using data from 124 transplant centers in the United States, with 11,572 patients with diabetes mellitus on the waiting list for pancreas transplantation (pancreas alone, pancreas-after-kidney, or simultaneous pancreas-kidney) at the United Network for Organ Sharing/Organ Procurement and Transplantation Network between January 1, 1995, and December 31, 2000.

The researchers found that over four years of follow-up, the transplant recipients, compared with patients awaiting the same procedure, had a 57 percent increased risk of death for pancreas transplant alone; 42 percent increased risk of death for pancreas-after-kidney transplant patients; and 57 percent decreased risk of death for simultaneous pancreas-kidney transplant "Transplant patient 1- and 4-year survival rates were 96.5 percent and 85.2 percent for pancreas transplant alone, respectively, and 95.3 percent and 84.5 percent for pancreas-after-kidney transplant, while 1- and 4-year survival rates for patients on the waiting list were 97.6 percent and 92.1 percent for pancreas transplant alone, respectively, and 97.1 percent and 88.1 percent for pancreas-after-kidney transplant," the authors write.

"Our data suggest that patients with complicated diabetes who are considering a solitary pancreas transplant must weigh the potential benefit of insulin independence against an apparent increase in mortality for at least the first 4 years posttransplantation. Benefits not accounted for in this analysis (e.g., improved quality of life) may justify pancreas transplantation, and it is possible that transplant recipients may show a survival advantage with longer-term follow-up. Even if that is true, however, it is at best difficult to weigh the cost of an early excess mortality (spanning the first 4 years posttransplant) against what at this point is a hypothetical survival advantage beyond the 4 years we have analyzed," the researchers write.

"At this point, clinicians and patients considering the pancreas transplant option must understand the actual risks and benefits, the expense, and the uncertainties associated with this surgical therapy. Our data suggest that the increasingly frequent application of the solitary pancreas transplantation option for those with normal kidney function warrants a second look," they conclude.

Joan Chamberlain | EurekAlert!
Further information:
http://www.ama-assn.org/
http://jama.com

More articles from Health and Medicine:

nachricht Norovirus evades immune system by hiding out in rare gut cells
12.10.2017 | University of Pennsylvania School of Medicine

nachricht Flexible sensors can detect movement in GI tract
11.10.2017 | Massachusetts Institute of Technology

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Neutron star merger directly observed for the first time

University of Maryland researchers contribute to historic detection of gravitational waves and light created by event

On August 17, 2017, at 12:41:04 UTC, scientists made the first direct observation of a merger between two neutron stars--the dense, collapsed cores that remain...

Im Focus: Breaking: the first light from two neutron stars merging

Seven new papers describe the first-ever detection of light from a gravitational wave source. The event, caused by two neutron stars colliding and merging together, was dubbed GW170817 because it sent ripples through space-time that reached Earth on 2017 August 17. Around the world, hundreds of excited astronomers mobilized quickly and were able to observe the event using numerous telescopes, providing a wealth of new data.

Previous detections of gravitational waves have all involved the merger of two black holes, a feat that won the 2017 Nobel Prize in Physics earlier this month....

Im Focus: Smart sensors for efficient processes

Material defects in end products can quickly result in failures in many areas of industry, and have a massive impact on the safe use of their products. This is why, in the field of quality assurance, intelligent, nondestructive sensor systems play a key role. They allow testing components and parts in a rapid and cost-efficient manner without destroying the actual product or changing its surface. Experts from the Fraunhofer IZFP in Saarbrücken will be presenting two exhibits at the Blechexpo in Stuttgart from 7–10 November 2017 that allow fast, reliable, and automated characterization of materials and detection of defects (Hall 5, Booth 5306).

When quality testing uses time-consuming destructive test methods, it can result in enormous costs due to damaging or destroying the products. And given that...

Im Focus: Cold molecules on collision course

Using a new cooling technique MPQ scientists succeed at observing collisions in a dense beam of cold and slow dipolar molecules.

How do chemical reactions proceed at extremely low temperatures? The answer requires the investigation of molecular samples that are cold, dense, and slow at...

Im Focus: Shrinking the proton again!

Scientists from the Max Planck Institute of Quantum Optics, using high precision laser spectroscopy of atomic hydrogen, confirm the surprisingly small value of the proton radius determined from muonic hydrogen.

It was one of the breakthroughs of the year 2010: Laser spectroscopy of muonic hydrogen resulted in a value for the proton charge radius that was significantly...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ASEAN Member States discuss the future role of renewable energy

17.10.2017 | Event News

World Health Summit 2017: International experts set the course for the future of Global Health

10.10.2017 | Event News

Climate Engineering Conference 2017 Opens in Berlin

10.10.2017 | Event News

 
Latest News

Ocean atmosphere rife with microbes

17.10.2017 | Life Sciences

Neutrons observe vitamin B6-dependent enzyme activity useful for drug development

17.10.2017 | Life Sciences

NASA finds newly formed tropical storm lan over open waters

17.10.2017 | Earth Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>