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      Transplante simultâneo de pâncreas-rim em portador de diabetes mellitus tipo 1 com insuficiência renal crônica: experiência inicial do Hospital Angelina Caron Translated title: Simultaneous pancreas-kidney transplant in patients with type 1 diabetes mellitus and chronic renal failure: initial experience of Hospital Angelina Caron

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          Abstract

          O transplante pancreático é a melhor opção para substituir a função endócrina da glândula em pacientes com diabetes do tipo 1 (DM1). Ao final de 2001, já haviam sido notificados mais de 17.000 transplantes de pâncreas ao International Pancreas Transplant Registry. Na atualidade o transplante reno-pancreático simultâneo é o melhor tratamento para pacientes com DM1 e insuficiência renal crônica. Neste estudo são apresentados os resultados do transplante simultâneo de rim-pâncreas (SRP) realizados em um centro brasileiro. MÉTODOS: De 01/2001 a 06/2002, 12 pacientes com DM1 e insuficiência renal associada foram submetidos a transplante SRP. A terapia imunossupressora consistiu de tacrolimus, micofenolato mofetil, esteróides e terapia de indução com basiliximab. RESULTADOS: No seguimento de 5,7 meses (1-18), as taxas de sucesso para pâncreas e rim foram respectivamente de 75% e 83%. A sobrevida dos pacientes foi de 83%. Ocorreram algumas complicações sérias, como trombose de 3 pâncreas (25%) e 2 rins (16%) e 2 fístulas ureterais (16%), porém nenhuma delas ocasionou óbito de qualquer paciente. Não ocorreu nenhum episódio de rejeição nos pacientes transplantados. Todos os doentes com enxertos funcionantes apresentam-se normoglicêmicos sem necessidade de insulina. CONCLUSÕES: Estes resultados demonstram que o SRP é um tratamento seguro e eficaz no manejo do doente diabético com insuficiência renal associada.

          Translated abstract

          Pancreatic transplant is the best method for replacing the endocrine function of the gland in patients with type 1 diabetes (DM1). At the end of 2001, more than 17,000 pancreas transplants had been reported to the International Pancreas Transplant Registry. At present, simultaneous pancreaticorenal transplantation is the best treatment for DM1 patients with chronic renal failure. We present the results of simultaneous pancreas-kidney (SPK) transplantation performed in a Brazilian center. METHODS: From 01/2001 to 06/2002, 12 patients with DM1 and associated renal failure received a SPK. Baseline immunosuppression consisted of tacrolimus, mycophenolate mofetil, steroids and induction therapy with basiliximab. RESULTS: With a mean follow-up of 5.7 months (range: 1-18), pancreas and kidney successful rates were respectively 75% and 83%. Survival rate was 83%. There were some major complications including 3 pancreas (25%) and 2 kidney (16%) venous thrombosis and 2 ureteral fistula (16%), but none related to patient death. No episode of rejection occurred in any of the transplanted patients. All patients with successful grafts are insulin-free since transplantation. CONCLUSIONS: These data show that SPK is a safe and effective treatment in the management of DM1 patients with associated renal failure.

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          Most cited references 31

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          Type 2 diabetes mellitus: the grand overview.

           R Ratner (1997)
          Type 2 diabetes currently accounts for over 100 billion dollars in annual healthcare expenditure in the United States and 28% of the national (Medicare) healthcare budget for elderly Americans. In our inner-city hospital, 20% of all 950 beds are occupied by patients with diabetes; and 28-38% of patients receiving cardiac care in Coronary Care Units, catheterization laboratories or cardiovascular surgery, have diabetes as an underlying disorder. Both computer modelling and controlled clinical trials suggest that intensive therapy of diabetes can reduce significantly the morbidity and costs associated with this increasingly common disorder. Early detection of carbohydrate intolerance holds great promise for preventing the onset, progression and complications of Type 2 diabetes. To date our efforts have been futile, with 20% of newly diagnosed Type 2 diabetic patients already complicated by retinopathy and 14% complicated by peripheral vascular disease. It is now clear that high-risk individuals can be identified, and intervention trials are underway to test the hypothesis that Type 2 diabetes (and its attendant cardiovascular risks) can be prevented. The Study to Prevent Non-Insulin-Dependent Diabetes Mellitus (STOP NIDDM) in Canada and Europe has randomized 1200 individuals with impaired glucose tolerance (IGT) into a three-year trial to prevent disease progression. The Diabetes Prevention Program (DPP) in the US has randomized almost 3000 individuals with IGT into a six-year, three-arm study testing the efficacy of intensive lifestyle and pharmacological therapy in disease progression. Together, these studies should provide a public health model for the recognition of high-risk individuals and interventions to stem the epidemic of Type 2 diabetes. For those patients suffering with Type 2 diabetes already, pancreas transplantation remains an extreme intervention with the potential for 'curing' diabetes. Although applied usually to patients with Type 1 diabetes, experience is accumulating of transplantation in Type 2 diabetic patients with end-stage renal disease. Outcomes for these individuals are as good as for Type 1 diabetes. Islet-cell transplants, in fact, have been more successful in Type 2 diabetes compared with Type 1. Improved islet-cell availability, better immunosuppression, and the possibility of antigen masking make this technology a major hope for the future.
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            Combined pancreas and kidney transplantation improves survival in patients with end-stage diabetic nephropathy

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              Human Islet Allotransplantation: World Experience and Current Status

              Currently type-I diabetes mellitus is treated with exogenous insulin administration, but traditional insulin therapy does not prevent long-term systemic complications and therefore alternatives should be sought. Presently the only option is to substitute the insulin-producing β cells in order to obtain a more physiological way to deliver insulin. Simultaneous kidney and pancreas transplantation is an established procedure. Pancreas transplantation, however, is a major surgical procedure with a high rate of complications. Transplantation of the isolated insulin-secreting islets of Langerhans is an alternative approach, which is easier and safer than whole organ transplantation. Since 1990, clinical trials of islet transplantation have begun in a few specialized centers worldwide and the International Islet Registry counting 305 human islet allografts at the end of 1995. Insulin independence at 1 year was achieved in 8% of the patients, but 20% of cases showed a graft function with a normal basal C peptide and improved glycemic regulation. We review here the different aspects of human islets of Langerhans allotransplatation, namely historical aspects, indications, isolation and purification procedures and the results obtained.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                abem
                Arquivos Brasileiros de Endocrinologia & Metabologia
                Arq Bras Endocrinol Metab
                Sociedade Brasileira de Endocrinologia e Metabologia (São Paulo )
                1677-9487
                June 2003
                : 47
                : 3
                : 243-247
                Affiliations
                [1 ] Hospital Angelina Caron Brazil
                Article
                S0004-27302003000300007
                10.1590/S0004-27302003000300007
                Product
                Product Information: website
                Categories
                ENDOCRINOLOGY & METABOLISM

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