DOCSLIB.ORG

Laparoscopic Donor Distal Pancreatectomy for Living Donor Pancreas and Pancreas–Kidney Transplantation

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Laparoscopic Donor Distal Pancreatectomy for Living Donor Pancreas and Pancreas–Kidney Transplantation American Journal of Transplantation 2005; 5: 1966–1970 Copyright C Blackwell Munksgaard 2005 Blackwell Munksgaard doi: 10.1111/j.1600-6143.2005.00950.x Laparoscopic Donor Distal Pancreatectomy for Living Donor Pancreas and Pancreas–Kidney Transplantation Miguel Tan, Raja Kandaswamy, David ER high panel-reactive antibody (PRA) who is unlikely to re- ∗ Sutherland and Rainer WG Gruessner ceive a cadaver organ. Before 1994, our institution only of- fered an LD pancreas transplant as a pancreas transplant Department of Surgery, Division of Transplantation, alone (PTA) or as a pancreas after kidney (PAK) transplant, University of Minnesota, MN because of the fear that multiorgan retrieval from an LD ∗ Corresponding author: Rainer WG Gruessner, entailed too much morbidity (4). With that approach, how- [email protected] ever, diabetic uremic patients had to endure two separate procedures, which many patients were loath to undergo. With the proliferation and expanding applications of Even today, patients will sometimes pass up a single organ laparoscopic techniques, we determined the applica- in order to undergo a simultaneous pancreas–kidney (SPK) bility of the laparoscopic approach to living pancreas transplant despite its prolonged waiting time. donation. We performed the first laparoscopic donor distal pancreatectomy in 1999. We herein present our It has also been demonstrated that diabetic patients on initial experience with five hand-assisted laparoscopic dialysis have increased morbidity and mortality, as com- donor pancreatectomies. Three donors underwent dis- pared with nondiabetic patients on dialysis. Diabetic pa- tal pancreatectomy alone; two underwent a simultane- tients undergoing a kidney transplant alone (KTA) have a ± ous left nephrectomy. The mean donor age was 48.4 higher mortality rate as compared with those undergoing 8.7 years with a body mass index of 23.7 kg/m2. The an SPK transplant (5,6). donor and recipient survival rate was 100% at up to 3 years of follow-up. There were no episodes of pan- creatitis, leaks, or pseudocysts. All donors returned to Consequently, we now perform LD SPK transplants in se- their preoperative state of health and to work. None lected patients to alleviate prolonged waiting time and to of the donors have required oral anti-diabetic medica- decrease the morbidity and mortality of diabetics awaiting tions or insulin. We conclude that laparoscopic donor a transplant. distal pancreatectomy is a safe and efficient procedure; hand-assisted laparoscopic distal pancreatectomy ap- Although the donor operation can be done safely, it is as- pears to be preferable, because of the added margin of sociated with postoperative morbidity related, in part, to safety from increased tactile feedback and ease of pan- the bilateral subcostal incision. The advent of laparoscopic creatic dissection. The procedure can be accomplished technology has offered an alternative to the open approach. with a single 6-cm periumbilical incision and only two 12-mm ports, resulting in excellent cosmesis and high Its viability has been demonstrated by laparoscopic donor donor satisfaction. nephrectomy, which has rapidly become the procedure of choice for kidney donation because of reduced hospital Key words: Laparoscopic pancreatectomy, living don- stay, decreased pain and more rapid convalescence (7,8). or, pancreas transplantation Cosmetically, laparoscopic donor nephrectomy is more ap- pealing to potential donors, as compared with the tradi- Received 28 October 2004, revised and accepted for tional flank incision required for open nephrectomy. It is publication 14 March 2005 equivalent to the open procedure in terms of donor safety and allograft quality (8). Introduction Laparoscopic techniques have rapidly been applied to other organ systems, including the pancreas. Laparoscopic dis- The pancreas was the first extrarenal organ to be success- tal pancreatectomies have been described for treatment fully used from living donors (LDs) (1). Yet, of the more of a variety of pathologic states. They appear to be safe, than 20 000 pancreas transplants performed since 1966, with the additional benefit of reduced hospital costs and fewer than 1% have come from LDs (2,3). Underuse of this accelerated postoperative recovery (9,10). resource can be attributed to concerns about the potential morbidity of an open distal pancreatectomy in an otherwise In an effort to decrease the morbidity associated with healthy donor. In selected cases, however, an LD pancreas open pancreas donation and to assess the applicability of transplant is an appropriate option, such as a recipient with this technology, we performed the first laparoscopic donor 1966 Laparoscopic Donor Pancreatectomy distal pancreatectomy in 1999. We herein present our ini- shears, laparoscopic scissors and other instruments. The surgeon and assis- tial experience with this procedure. tant stood on the donor’s left side. Mobilization of the left colon, the ureter and the left gonadal vein, as well as dissection of the kidney, is described elsewhere (12). Before ligation of the renal vessels, the donor was given Methods 70 units/kg of intravenous heparin, the effect of which was reversed with protamine sulfate (10 mg/1000 units heparin) after the vessels were ligated. Preoperative donor evaluation The renal artery was ligated with two Hem-o-lok clips (Weck Closure Sys- From March 1999 through August 2003, we performed five hand-assisted tems, Research Triangle Park, NC), then divided with laparoscopic scissors. laparoscopic donor pancreatectomies at the University of Minnesota. All The renal vein was ligated with a 35-mm vascular stapler (ETS Flex Enco- donors underwent an extensive multidisciplinary workup involving endocri- scopic Articulating Linear Cutter, Ethicon Endosurgery, Cincinnati, OH). The nologists, nephrologists, cardiologists, social service personnel, psychia- kidney was extracted by hand through the midline incision and passed off trists and transplant surgeons. Potential pancreas donors were only con- to the recipient surgical team. sidered if they fit the following criteria: body mass index (BMI) <27 kg/m2, insulin response to glucose or arginine >300% of basal insulin, HgbA1c The donor was then rotated to a supine position with reverse Trendelenburg <6%, basal insulin fasting levels <20 umol/L, plasma glucose <150 mg/L positioning. The inferior margin of the pancreas was completely mobilized during a 75-g oral glucose tolerance test and a glucose disposal rate >1% by using ultrasonic shears and electrocautery. The inferior mesenteric vein during an intravenous glucose tolerance test. In genetically related donors, (IMV) was identified, ligated with staples, and divided near its insertion into no other family members other than the recipient could be diabetic. A ge- the splenic vein. The tail of the pancreas was encircled with a finger: a hole netically related donor had to be at least 10 years older than the recipient was made in the avascular plane along the superior margin of the pancreatic was at the time of onset of diabetes in the recipient. Other contraindications tail and then a finger was passed along the underside of the pancreas. The to donation included a history of gestational diabetes and previous pancre- tail was encircled with a blue vessel loop, in order to facilitate atraumatic atic surgery or disorders. All potential donors during this time period that anterior retraction of the pancreas. The posterior surface of the pancreas met the aforementioned criteria were eligible for laparoscopic donation. No was freed from its retroperitoneal attachments by using electrocautery. The open procedures were performed. splenic artery and vein were identified in the hilum of the spleen and indi- vidually ligated and divided using a 35-mm vascular stapler. Care was taken Radiologic evaluation not to disturb the short gastric and right gastroepiploic vessels, because We evaluated each potential donor’s vascular anatomy to determine suit- they constituted the major remaining blood supply to the spleen. ability for pancreas donation. At our center, magnetic resonance angiogra- phy (MRA) is the modality of choice because of its noninvasive nature and With the pancreas mobilized medially, the splenic artery was mobilized just its ability to discern parenchymal details and to provide details of venous as it bifurcated off the celiac axis; likewise, the splenic vein was mobilized anatomy (11). Of interest is the anatomy of the splenic vessels, specifically circumferentially near its junction with the SMV (Figure 1). Before ligation the takeoff of the splenic artery and the location of the confluence of the of the vessels, heparin (30 units/kg) was administered. Protamine was ad- splenic vein and superior mesenteric vein (SMV). MRA also allows evalu- ministered after the vessels were divided. Two clips were applied to the ation of the location and number of renal vessels, in case a simultaneous splenic artery just distal to the celiac axis (Figure 2), then divided with la- nephrectomy is to be done. The decision to procure the left or right kidney paroscopic scissors. Two staples were applied to the splenic vein at the is made on a case-by-case basis according to the number and location of level of its junction with the SMV, and then divided. A 45-mm ETS Flex Lin- accessory renal vessels. Our preference, however, is to procure the left ear Articulating Stapler (Ethicon Endosurgery, Cincinnati, OH) was used to kidney, because of the longer renal vein and subsequent ease
Load more

Recommended publications
  • 2Nd Quarter 2001 Medicare Part a Bulletin
    In This Issue... From the Intermediary Medical Director Medical Review Progressive Corrective Action ......................................................................... 3 General Information Medical Review Process Revision to Medical Record Requests ................................................ 5 General Coverage New CLIA Waived Tests ............................................................................................................. 8 Outpatient Hospital Services Correction to the Outpatient Services Fee Schedule ................................................................. 9 Skilled Nursing Facility Services Fee Schedule and Consolidated Billing for Skilled Nursing Facility (SNF) Services ............. 12 Fraud and Abuse Justice Recovers Record $1.5 Billion in Fraud Payments - Highest Ever for One Year Period ........................................................................................... 20 Bulletin Medical Policies Use of the American Medical Association’s (AMA’s) Current Procedural Terminology (CPT) Codes on Contractors’ Web Sites ................................................................................. 21 Outpatient Prospective Payment System January 2001 Update: Coding Information for Hospital Outpatient Prospective Payment System (OPPS) ......................................................................................................................... 93 he Medicare A Bulletin Providers Will Be Asked to Register Tshould be shared with all to Receive Medicare Bulletins and health care
    [Show full text]
  • Pancreas Transplantation: Review Transplante De Pâncreas: Revisão
    REVIEW THEMATIC REVIEW: TRANSPLANTATION Pancreas transplantation: review Transplante de pâncreas: revisão Roberto Ferreira Meirelles Júnior1, Paolo Salvalaggio1, Alvaro Pacheco-Silva1,2 ABSTRACT Europa. A introdução dos imunossupressores tacrolimo e micofenolato Vascularized pancreas transplantation is the only treatment that mofetila, a partir de 1994, propiciou a melhora significativa dos resultados establishes normal glucose levels and normalizes glycosylated e a consequente realização de transplantes em escala crescente em hemoglobin levels in type 1 diabetic patients. The first vascularized vários países. Segundo o Registro Internacional de Transplante de pancreas transplant was performed by William Kelly and Richard Lillehei, Pâncreas, foram realizados, até 31 de dezembro de 2010, mais de 35 to treat a type 1 diabetes patient, in December 1966. In Brazil, Edison mil transplantes de pâncreas. Sobrevida no primeiro ano dos pacientes e dos enxertos pancreáticos excede, respectivamente, 95 e 83%. A Teixeira performed the first isolated segmental pancreas transplant in melhor sobrevida dos enxertos pancreático (86%) e renal (93%), 1968. Until the 1980s, pancreas transplants were restricted to a few no primeiro ano pós-transplante, está na categoria de transplante centers of the United States and Europe. The introduction of tacrolimus simultâneo de pâncreas e rim. As perdas imunológicas no primeiro and mycophenolate mofetil in 1994, led to a significant outcome ano pós-transplante para transplante simultâneo de pâncreas e rim, improvement and consequently, an increase in pancreas transplants transplante de pâncreas após rim e transplante de pâncreas isolado in several countries. According to the International Pancreas Transplant foram, respectivamente, 1,8, 3,7, e 6%. O transplante de pâncreas Registry, until December 31st, 2010, more than 35 thousand pancreas apresenta de 10 a 20% de complicações cirúrgicas, necessitando transplants had been performed.
    [Show full text]
  • Colorectal Cancer After Kidney Transplantation: a Screening Colonoscopy Case-Control Study
    biomedicines Article Colorectal Cancer after Kidney Transplantation: A Screening Colonoscopy Case-Control Study Francesca Privitera 1, Rossella Gioco 1 , Alba Ilari Civit 1, Daniela Corona 2, Simone Cremona 1, Lidia Puzzo 3, Salvatore Costa 1, Giuseppe Trama 4, Flavia Mauceri 5, Aurelio Cardella 5, Giuseppe Sangiorgio 6, Riccardo Nania 6, Pierfrancesco Veroux 7 and Massimiliano Veroux 1,7,* 1 General Surgery, University Hospital of Catania, 95123 Catania, Italy; [email protected] (F.P.); [email protected] (R.G.); [email protected] (A.I.C.); [email protected] (S.C.); [email protected] (S.C.) 2 Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; [email protected] 3 Pathology Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, 95123 Catania, Italy; [email protected] 4 Gastroenterology Unit, University Hospital of Catania, 95123 Catania, Italy; [email protected] 5 Faculty of Medicine, University of Catania, 95123 Catania, Italy; maucerifl[email protected] (F.M.); [email protected] (A.C.) 6 Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy; [email protected] (G.S.); [email protected] (R.N.) 7 Organ Transplant Unit, University Hospital of Catania Department of Medical and Surgical Sciences and Advanced Technologies, 95123 Catania, Italy; [email protected] * Correspondence: [email protected] Citation: Privitera, F.; Gioco, R.; Civit, A.I.; Corona, D.; Cremona, S.; Abstract: The incidence of colorectal cancer in kidney transplant recipients has been previously Puzzo, L.; Costa, S.; Trama, G.; reported with conflicting results. In this study, we investigated if the incidence of colorectal ad- Mauceri, F.; Cardella, A.; et al.
    [Show full text]
  • Glucose Control During and After Pancreatic Transplantation
    In Brief to Practice Research From / With Acute Care of Patients Diabetes Pancreas transplantation is considered the best treatment option for patients with type 1 diabetes and renal failure. In this article, the authors describe peri- operative glucose control in patients undergoing pancreas or kidney-pancreas transplantation. Glucose Control During and After Pancreatic Transplantation After decades of controversy sur- graft survival rates are 72% for PAKT rounding the therapeutic validity of and 71% for PA.1,2 pancreas transplantation (PTX), the The Diabetes Control and Comp- M. Hosein Shokouh-Amiri, MD; procedure has become accepted as the lications Trial (DCCT) has clearly Robert J. Stratta, MD; Kashif A. preferred treatment for patients with shown that improved glycemic control Latif, MD; and Osama Gaber, MD insulin-requiring diabetes mellitus and lowers the risk of secondary diabetic advanced diabetic nephropathy. The complications.3 However, intensive trade-offs for normal glucose home- insulin therapy did not result in nor- ostasis are the operative risks of the malization of hemoglobin A1c (HbA1c) transplant procedure and the need for levels, was associated with a threefold chronic immunosuppression. Free islet increased risk of severe hypoglycemia, grafts have the same potential but do and was resource-intensive. The not approach PTX in terms of consis- results of the DCCT provide a strong tency of results. rationale for pancreas transplantation. From December 1966 to October 2000, more than 15,000 PTX proce- Recipient Selection
    [Show full text]
  • Pancreas Transplantationtransplantation
    PancreasPancreas TransplantationTransplantation Tayyab S. Diwan, MD Surgical Director of Pancreas Transplantation Division of Transplantation University of Cincinnati PancreasPancreas AnatomyAnatomy PancreasPancreas PhysiologyPhysiology z Exocrine – Digestion of lipids and proteins – Pre-Cursors: Trypsinogen, chymotrypsinogen, lipase and amylase – Enterokinase bound to enterocytes in the duodenum PancreasPancreas PhysiologyPhysiology z Endocrine – Regulate serum blood sugar – Islets of Langerhans z B-cells produce Insulin – stimulates cells to use glucose z A-cells produce Glucagon – increases serum gulcose by binding to hepatocyte receptors – Glycogen to glucose TheThe RoleRole ofof InsulinInsulin z Polypeptide that regulates carbohydrate metabolism z Allows cells to use serum glucose z Inhibits liver glycogen breakdown PancreasPancreas PhysiologyPhysiology HistoryHistory ofof thethe PancreasPancreas z Discovered by Herophilus, Greek anatomist and surgeon, in 336 BC z 400 years later Ephesus, Greek anatomist- surgeon, rediscovered the organ and named in ‘Pan-Kreas’ z Galen (138-201AD): ‘Physician to the Gladiators’ and the Roman Emperor – Pancreas serves as a cushion to blood vessels – No further scientific investigation until the 18th century HistoryHistory ofof thethe PancreasPancreas z Johann Wirsung, in 1642, discovers the pancreatic duct in Italy z Paul Langerhans, in 1869, a student at the Berlin Institute of Pathology, describes histology z Late 1800’s introduce aseptic operative technique advancing research in human and animal models HistoryHistory ofof thethe PancreasPancreas andand DMDM z Frederick Banting and Charles Best, in 1921 at the Univ of Toronto credited with the discovery of insulin z Working from JJR Macleod’s lab, James Bertram Collip, PhD extracted the insulin HistoryHistory ofof PancreasPancreas andand DMDM z No IRB…No Problem z 6 months after 1st successful dog z 14 yo Leonard Thompson injected with purified dog insulin HistoryHistory ofof PancreasPancreas andand DMDM z The Canadian aftermath….
    [Show full text]
  • Superior Long-Term Survival for Simultaneous Pancreas–Kidney
    Diabetes Care 1 Kevin Esmeijer,1 Ellen K. Hoogeveen,1,2 Superior Long-Term Survival for Paul J.M. van den Boog,1 Cynthia Konijn,3 CLIN CARE/EDUCATION/NUTRITION/PSYCHOSOCIAL – Marko J.K. Mallat,1 Andre G. Baranski,4 Simultaneous Pancreas Kidney Olaf M. Dekkers,2,5 and Johan W. de Fijter,1 Transplantation as Renal on behalf of the Dutch Transplant Centers Replacement Therapy: 30-Year Follow-up of a Nationwide Cohort https://doi.org/10.2337/dc19-1580 OBJECTIVE In patients with type 1 diabetes and end-stage renal disease, it is controversial whether a simultaneous pancreas–kidney (SPK) transplantation improves survival compared with kidney transplantation alone. We compared long-term survival in SPK and living- or deceased-donor kidney transplant recipients. RESEARCH DESIGN AND METHODS We included all 2,796 patients with type 1 diabetes in the Netherlands who started renal replacement therapy between 1986 and 2016. We used multivariable Cox regression analyses adjusted for recipient age and sex, dialysis modality and vintage, transplantation era, and donor age to compare all-cause mortality between deceased or living-donor kidney and SPK transplant recipients. Separately, we analyzed mortality between regions where SPK transplant was the preferred intervention (80% SPK) versus regions where a kidney transplant alone was favored 1Department of Nephrology, Leiden University (30% SPK). Medical Center, Leiden, the Netherlands 2Department of Clinical Epidemiology, Leiden RESULTS University Medical Center, Leiden, the Nether- Of 996 transplanted patients, 42%, 16%, and 42% received a deceased or living- lands 3Netherlands Organ Transplantation Registry, donor kidney or SPK transplant, respectively. Mean (SD) age at transplantation was Leiden, the Netherlands 50 (11), 48 (11), and 42 (8) years, respectively.
    [Show full text]
  • Have We Learned from Our Mistakes in Pancreas Transplantation?
    Have we learned from our mistakes in pancreas transplantation? Chris Watson Addenbrooke’s NHS UNIVERSITY OF Cambridge University Hospitals Foundation Trust CAMBRIDGE Learning from mistakes The Pancreas Forum Annual Report on Pancreas transplantation ¡A forum for learning from the mistakes of others ¡Benchmarking centres ¡ And their good practice against their peers ¡Annual meeting, now in ¡Providing data for th National Pancreas Transplant Forum 2018 Venue: Radisson Blu Hotel, Cardiff CF10 2FL its 14 year Date: 2nd February 2018 patients PROGRAMME 9:00 Welcome 9:15 NHSBT Annual Pancreas and Islet Transplant Report 2016/17 Claire Counter 9:45 National Data on the impact of pancreas quality and retrieval logistics on the transplant outcome Claire Counter 10:00 Pancreas Discard Rate in UK – Are we all saying the same thing? Sorina Cornateanu (Edinburgh) 10:30 Discussion 10:45- 11:00 Coffee/Tea Break 11:00 Trends in pancreas transplantation – USA Raja Kandaswamy (USA) 11:40 Trends in pancreas transplantation – UK Argiris Asderakis (Cardiff) 12:00 Discussion 12:30 Lunch 13:30 Pancreas Transplantation in Type 2 DM Sanjay Sinha (Oxford) Raja Kandaswamy (USA) 14:15 Update on Immunotherapy Trials on Type 1 DM Colin Dayan (Cardiff) 14:45 Discussion 15:00-15:15 Coffee/Tea Break 15:15-16:15 Case presentations Cambridge, Edinburgh, Guys, Hammersmith, Manchester, Newcastle, Oxford, Cardiff Acknowledgements ¡Claire Counter Mistakes? ¡Questions ¡ What did we get right (if anything)? ¡ What are our mistakes? ¡ Did we learn from them? ¡Considerations ¡
    [Show full text]
  • Classic Diseases Revisited Chronic Pancreatitis
    Postgrad Med J 1996; 72: 327 - 333 (© The Fellowship of Postgraduate Medicine, 1996 Classic diseases revisited Postgrad Med J: first published as 10.1136/pgmj.72.848.327 on 1 June 1996. Downloaded from Chronic pancreatitis: diagnosis and treatment Summary Three-dimensional magnetic reson- ance cholangiopancreatography is Sandeep Sidhu, Rakesh K Tandon currently the most exciting new ima- ging technique for chronic pancrea- titis. Endoscopy-assisted duodenal intubation during the secretin-cho- Chronic pancreatitis is prevalent in most parts of the world although its lecystokinin test reduces intubation aetiology and clinical course may vary in different regions. Community-based time in difficult cases. The NBT- field studies from our centre have revealed that tropical chronic pancreatitis in para-amino benzoic acid test has Southern India is a mild disease with onset of symptoms in early adulthood,' been refined to enhance its discri- and a prevalence of 1:793 in endemic areas. The predominant symptoms are minant power. The cholesteryl- abdominal pain (30.6%), diabetes mellitus (52.8%) and malabsorption [C13]octanoate breath test and the (16.7%).' On the other hand, patients presenting to office practice,2 or to local faecal elastase test are newer highly or tertiary care hospitals3 have severe chronic pancreatitis, with abdominal pain sensitive and specific tubeless tests. as the predominant symptom (approximately 80%); exocrine pancreatic Pain in chronic pancreatitis con- insufficiency and calcification are seen in 80 - 90% patients.2 In a recent tinues to be a vexing therapeutic study,3 surgical treatment for pain was required in 53.9% of chronic pancreatitis issue. Enzyme treatment continues patients referred to the All India Institute ofMedical Sciences, a leading tertiary despite criticism.
    [Show full text]
  • 2009 Transplant Recipient Guideline
    2009 • VOL 9 • SUPPLEMENT 3 American Journal of Transplantation • Volume 9 • Supplement 3 • November 2009 • PP. 1–156 ajt_9_S3-cover 10/8/09 17:16 Page 1 ajt_9_11-mast head 9/24/09 17:57 Page 3 EDITOR-IN-CHIEF OFFICIAL JOURNAL OF THE AMERICAN SOCIETY OF TRANSPLANTATION AND THE AMERICAN SOCIETY OF TRANSPLANT SURGEONS Philip F. Halloran, Canada DEPUTY EDITORS Jonathan S. Bromberg, USA Robert L. Fairchild, USA Sandy Feng, USA Bruce Kaplan, USA American Journal of Mark L. Barr, USA John O’Grady, UK EDITORIAL OFFICE Dellice Berezan Gillian Hughes Editorial Office Administrators University of Alberta 250 Heritage Medical Research Centre Edmonton, Alberta T6G 2S02 Phone: +1-780-492-1752 Transplantation Fax: +1-780-407-3417 E-mail:[email protected] DELIVERY TERMS AND LEGAL TITLE Prices include delivery of print journals to the recipient’s address. Delivery terms are Delivered Duty Unpaid (DDU); the recipient is responsible for paying any ASSOCIATE EDITORS import duty or taxes. Legal title passes to the customer on despatch by our distributors. Bryan Becker, USA Emily Blumberg, USA BACK ISSUES J. Andrew Bradley, UK Single issues from current and recent volumes are available at the current single issue price from [email protected]. Earlier issues may be obtained from Daniel Brennan, USA Periodicals Service Company, 11 Main Street, Germantown, NY 12526, USA. Tel: +1 518 537 4700, Fax: +1 518 537 5899, Email: [email protected] David M. Briscoe, USA American Journal of Transplantation, (ISSN 1600-6135), is published monthly on behalf of American Society of Transplantation and the American Society of Ginny L.
    [Show full text]
  • Pancreas Transplantation Tients with AIDS Who Underwent Percutaneous Robert]
    374 Letters to the Editor ] Am Coil Surg Dr. Barie has described a small series of pa­ Pancreas Transplantation tients with AIDS who underwent percutaneous Robert]. Corry, MD, FACS, and Thomas E. Starzl, cholecystostomy for acute cholecystitis, with good results and little associated morbidity. Because of MD, phD, FACS, Professors of Surgery, Pittsburgh, PA this limited experience, he suggests that this is the The article entitled " ...Surgical Risk of Pancreas "standard of care" at his institution. Percutaneous Transplantation ..." by Gruessner, Sutherland, and cholecystostomy has a distinct role in the manage­ associates in the August issue emphasizes several im­ ment of patients for whom the risks of operative portant points about this complex procedure, which intervention and anesthesia are overwhelming. is still viewed as "experimental" by several health care But our institutional experience and an extensive funding agencies, including the Health Care Financ­ review of the literature suggest that surgery is con­ ing Administration. traindicated in only the smallest minority of pa­ The Minnesota group, which initiated the clini­ tients with AIDS-related biliary disease. We have cal procedure in 1966,1 has pioneered the evolution demonstrated that cholecystectomy is a safe inter­ of pancreas transplantation for the past 3 decades vention in this population of patients. Cholecys­ under the direction of David Sutherland. The ques­ tectomy resolves the pathology by removing the tion has always been raised whether the procedure, infected organ and provides more lasting benefit. which is associated with considerable morbidity, is The expected survival after a bout with cholecys­ worth the potential risk. The authors have presented titis is measured in years, not weeks or months.
    [Show full text]
  • Pancreas Transplant Procedures MCG-017
    Subject: Pancreas Transplantation Procedures (Pancreas Alone, Simultaneous Original Effective Date: Pancreas and Kidney, Pancreas after Kidney and Pancreatic Islet Cell and 6/14/06 Retransplantation) Policy Number: MCP-017 Revision Date(s): 8/28 /07, 8/ 25/ 10, 10/31/12 , 5/26 /15 , 4/23 /20 Review Date: 12/16/15 , 12/14/16, 6/22/17, 9/13/ 18 , 9/18/ 19 , 4/23 /20 , 6/ 29/21 MCPC Approval Date: 6/22/ 17, 9/13/ 18 , 9/18/19 , 4/23/20 , 6/ 9/21 Contents DISCLAIMER ............................................................................................................................................................................ 1 Description of Procedure/Service/Pharmaceutical .................................................................................................................. 1 POSITION STATEMENT RECOMMENDATION ............................................................................................................................ 2 Continuation of Therapy ......................................................................................................................................................... 6 Limitations .............................................................................................................................................................................. 6 Summary of Medical Evidence ............................................................................................................................................... 6 Coding Information ................................................................................................................................................................
    [Show full text]
  • 632 Small Bowel, Liver, and Multivisceral Transplant
    Medical Policy Small Bowel/Liver and Multivisceral Transplant Table of Contents • Policy: Commercial • Coding Information • Information Pertaining to All Policies • Policy: Medicare • Description • References • Authorization Information • Policy History Policy Number: 632 BCBSA Reference Number: 7.03.05 NCD/LCD: National Coverage Determination (NCD) for Intestinal and Multi-Visceral Transplant (260.5) Related Policies Isolated Small Bowel Transplant, #631 Policy Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity A small bowel/liver transplant or multivisceral transplant may be MEDICALLY NECESSARY for pediatric and adult patients with intestinal failure (characterized by loss of absorption and the inability to maintain protein-energy, fluid, electrolyte, or micronutrient balance) who have been managed with long-term total parenteral nutrition (TPN) and who have developed evidence of impending end-stage liver failure. A small bowel/liver retransplant or multivisceral retransplant may be MEDICALLY NECESSARY after a failed primary small bowel/liver transplant or multivisceral transplant. In addition to the above information, we do not cover small bowel/liver transplant or multivisceral transplantation when any of the following conditions are present: • Known current malignancy, including metastatic cancer • Recent malignancy with high risk of recurrence o Note: the assessment of risk of recurrence for a previously treated malignancy is made by the transplant team; providers must submit a statement with an explanation of why
    [Show full text]