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A year, 85% pancreas grafted do not need insulin
Although they have already more than forty years of life, pancreas transplants are not as numerous as those of other solid organs, since they are carried out mainly in diabetics in dialysis situation that have already evolved their disease.
80 percent of pancreas transplants do not have limitations in their long -term daily activity and 85 percent leave insulin per year of the intervention, according to data from the International Pancreatic Transplant Registry where more than 28,000 patients appear.These figures could be improved with more early transplants, before the secondary complications of diabetes appear.
For Daniel Casanova, professor of surgery, whose team has carried out numerous pancreatic transplants at the Valdecilla Hospital, in Santander, "this is the Cinderella and the most unknown transplant, although they began to be done for forty years.The main difference with those of liver or kidney is that it does not serve to save lives immediateAn oncological therapy. "
Therefore, experts insist on spreading the true objective of the pancreatic implant, which allows diabetes patients to dispense with insulin and rigorous dietary controls to be able to compensate for their metabolic imbalance after the intervention.
Casanova underlines the serious clinical repercussions of the neuropathy and retinopathy of diabetes of worse evolution, pathologies that can be stopped/cured with a pancreatic transplant and, generally, with the simultaneous transplant of kidney."In the long run, in addition to health benefits, the high social and economic cost is reduced in part by the abandonment of insulin and also by reducing hospital income," he explains to a medical newspaper.
The surgeon has broken down the details of the procedure, from the different surgical techniques to the current results and future forecasts, before a very varied medical hearing in the XVII Cooperation Days of the Hispanic-Argentina Association of Medicine, which have been held in Murcia.
In his opinion, it is important to raise awareness among the professionals involved (surgeons, nephrologists, endocrine, internists, etc.) of the importance of these transplants for diabetic patients who are on dialysis and are under 50 years.
But there are limitations: "To the extent that the doctors who treat them know the good results, the number of receptors in our units increases, but the demand for the enormous disproportion between the number of receptors and donors available cannot be fired."
Precocious phases
Casanova regrets that, despite the excellent results of recent years -95 percent survival to the year of the intervention-, the pancreas transplants into a very evolved phase of diabetes, when the kidney already fails, but should be done withGreater precocity to avoid secondary complications. "Thus defends the infrautilized indication of isolated pancreas transplantation, although only in selected patients.
Although theSimultaneous kidney and pancreas transplants are those that lead these therapies, since they usually apply to patients with nephropathy and dialysis dependent, the pancreas transplant is also practiced after the renal (and vice versa), or that of solitary pancreas.This pancreas isolated transplant is only used in unstable diabetics, those that suffer acute metabolic disorders, but still do not have the secondary complications of the disease.
"In many the pancreas implant could be done before and they would be released from diabetes, but we still do not have reliable markers about the evolution of these patients before these complications appear, or on which period of appearance they can have to advance with thetransplant".
The counterpart is that sometimes the patient is transplanted with a very severe nephropathy, already with collateral damage, or a retinopathy so advanced that it cannot improve."Retinopathy cannot be reversed; it would be like trying to recover an iron when it is already oxidized."
Surgical innovations in these transplants are also varied, but the most frequent model is that of intestinal derivation because it is the most physiological."The pancreas transplant is delicate because the diabetic patients are delicate, but today no nephrologist could say that it is not done. Although there has been a surgical refinement thanks to the general consensus, we can say that the greatest advance has been given from the point ofImmune view, with treatments as standardized as in the rest of organ transplants. "
routes with future
Daniel Casanova says that the usefulness of pancreatic implants can no longer be discussed, which previously called into the medical community itself.The pancreas come from young multiorganic donors and have decreased surgical complications, despite the fact that diabetic patients usually have remarkable atherosclerosis."Pancreatic islet transplants can also be used, which give good results, but a high number of donors is also needed; so the investigation is now directed to obtain them from pancreas of animals. Another open path to the future can be cell therapy can be"
