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90 patients with chronic diarrhoea underwent this prospective study. They were seen in a private hospital of Lima during 1990 and 1991. According to a methodologic plan for determining sources and the diseases that originate chronic diarrhoea. In all patients hematologic, bioquimic, coprocultures, coproparasitologic exams were done, chest and intestinal transit X-rays. All underwent duodenal content culture. Colon X-ray in 25 cases; proctosigmoidoscopy in 14 and upper digestive endoscopy in 19 patients. Abdominal echography in 12 and TAC in 2 cases. The final results showed as determinant diseases for chronic diarrhoea, according to their frequency: enteroparasitosis (23.3%), functional digestive disorders (20.0%), intestinal bacterial overpopulation (15.5%) of unknown origin (8.8%), colon diverticulus (7.7%) proven and probably (5.5%), lactose intolerance (3.3%), diabetes mellitus (2.2%), and in one case (1.1%) the following: intestinal linfoma, pancreas malignancy, AIDS, colonic and deformation and megaloblastic anemia. The causes of chronic diarrhoea are several and multifactorals and in this study we prove the preeminence of the intestinal parasitosis, functional disorders and intestinal bacterial overpopulation and with less frequency other pathologies.
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PMID:[Clinical and etiologic study of 90 cases of chronic diarrhea]. 821 99

We report the case of a 28-year-old woman attending for hirsutism and diabetes mellitus. Diabetes was a casual finding 2 years before consulting and was treated with diet and antidiabetic drugs. Acromegalic appearance, facial acne, penty, curled and rude hair, hypertrichosis, ade I diffuse goitre, prominent abdomen with umbilical hernia, severe hepatomegaly, prominent muscles and veins with normal genitalia appeared in the physical examination. No other abnormalities were found. Hypophysis, thyroid, suprarenal and ovaric hormonal functional studies were normal. An insulin-resistant diabetes mellitus was found in the metabolic study. Ultrasound and TAC showed severe diffuse hepatomegaly and visceral fat lack. Bone radiographies showed diffuse lesions compatible with polyostotic dysplasia. Subcutaneous, hepatic and bone biopsy revealed lack of fat tissue, hepatic steatosis and osteal fibrosis. Patient s diagnosis was Berardinelli-Seip syndrome, Seip-Lawrence or lipoatrophic diabetes associated with polyostotic fibrotic dysplasia. Case is studies and bibliographic references are reviewed.
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PMID:[Seip-Lawrence syndrome associated with polyostotic fibrous dysplasia. Report of a case]. 923 83

As of September 1999, almost 13,000 pancreas transplants had been reported to the IPTR, > 9,000 in the US and > 3,000 outside the US. An era analysis of US cases from 1987 to 1997 showed a progressive improvement in outcome (p < 0.04), with pancreas transplant graft survival rates (GSRs) going from 74% to 85% at one year for SPK cases, from 56% to 75% for PAK cases, and from 50% to 69% for PTA cases. The improvements were due both to decreases in technical failure (TF) rates (overall from 16% to 8%) and immunological failure rates (going from 6% to 2% for SPK, from 23% to 7% for PAK, and from 35% to 9% for PTA cases). The proportion of recipients > 44 years old increased from 5% to 24%, and the improved outcomes encompassed the older patients as well. In patients > 44 years old, SPK pancreas GSRs at one year increased from 69% for 1987-89 cases to 79% for 1996-97 cases (p < 0.03). Pancreas GSRs were also similar for recipients reported to have Type I or Type II diabetes (at 1 year, 84% and 81%, respectively, for 1994-99 SPK transplants), the latter designated in 3% of the recipients. Contemporary pancreas transplant outcomes were calculated separately for 1996-99 US and non-US cases. US patient survival rates at one year were > or = 95% in each recipient category, with one year pancreas GSRs of 84% for SPK (n = 2,502), 76% for PAK (n = 404), and 72% for PTA (n = 176) (p = 0.0001). The immunological graft failure rates for 1996-99 US SPK, PAK and PTA cases were 2%, 6%, and 10% at one year (p = 0.001). There was a progressive increase in the use of ED (as opposed to BD) for duct management, up to nearly 60% of US pancreas transplants by 1998. Approximately 18% of SPK ED transplants had venous drainage via the portal system. Pancreas GSRs were not significantly different for 1996-99 ED (n = 1,170) and BD (n = 1,203) US SPK transplants (84% and 85%, respectively, at 1 year), nor was there any difference in pancreas GSRs for systemic (n = 437) versus portal (n = 194) venous drained ED SPK transplants (84% and 83%, respectively, at 1 year). Interestingly, kidney GSRs were significantly higher for ED versus BD US SPK cases, 93% versus 84% at one year (p = 0.003). Duct management did matter for solitary (PAK and PTA) pancreas transplants. PAK pancreas GSRs were 80% at one year for BD (n = 238) versus 68% for ED (n = 156) US transplants. PTA pancreas GSRs were 78% at one year for BD (n = 98) versus 63% for ED (n = 73) US transplants. However, BD transplants were associated with a 12% conversion rate to ED by 2 years after transplantation. Analyses of outcome by immunosuppression for US cases showed pancreas GSRs to be higher in SPK recipients given MMF (87% at 1 year) than in those who were not (76% at 1 year). For PAK and PTA recipients, those given anti-T cell for induction and TAC and MMF for maintenance immunosuppression had the highest GSRs: 86% and 83%, respectively, at one year for BD pancreas transplants; not significantly different from the pancreas GSR (87% at 1 year) in BD SPK recipients also given anti-T cell for induction and TAC and MMF for maintenance immunosuppression. Analyses of US pancreas transplant outcome according to HLA matching showed no effect at all in the SPK category, while for PAK and PTA transplants an effect was seen at the A and B loci, strongest at the B loci. Matching for at least one antigen at both loci was associated with one-year pancreas GSRs of 85% for PAK and 74% for PTA, versus 70% and 60%, respectively, at one year for those who were not matched for at least one antigen at both the A and B loci. In regard to non-US cases, the overwhelming majority were in the SPK category (n = 528 for 1996-99), with one-year pancreas GSR of 79%, not significantly different from US cases. Approximately 40% of non-US SPK cases were ED (n = 204), and, as in the US, the pancreas GSRs were similar for ED and BD transplants in this category. (ABSTRACT TRUNCATED)
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PMID:Analyses of pancreas transplant outcomes for United States cases reported to the United Network for Organ Sharing (UNOS) and non-US cases reported to the International Pancreas Transplant Registry (IPTR). 1103 25

Our experience with other chronic diseases, such as hypertension, diabetes, and asthma, has shown that adherence to treatment over time is about 50%. In HIV treatment, a significantly higher rate of adherence (i.e., 95% or greater) is required to achieve good outcomes. HAART is effective and cost-effective. Even with the high cost of antiretroviral drugs, the decrease in hospital utilization in addition to improved quality of life with HAART more than offsets the increased cost of drugs. This cost shifting from hospital utilization has been shown to result in a decrease of total monthly costs of care in many settings. In addition to decreased mortality and cost savings from decreased hospital utilization associated with HAART, the appropriate use of expensive antiretroviral drugs and the resultant reduction in antiretroviral resistance can save lives and money over the long term. However, we know that the performance of drugs in clinical trials is not always borne out in today's real world of ambulatory HIV care, underscoring the need for treatment adherence strategies in the HAART era. Our understanding of what improves adherence to antiretroviral treatment is still incomplete. However, there are a number of approaches that address the patient, the provider/multidisciplinary team, and the treatment regimen itself. The dedicated TAC, while not the only solution, has been shown to be an effective team member and a solution worth considering in managed care settings. When added to the costs of today's care, this team member should still prove cost-effective in the final analysis.
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PMID:Treatment adherence improves outcomes and manages costs. 1127 75

As of October 2000, > 15,000 pancreas transplant had been reported to the IPTR, > 11,000 in the US and > 4,000 outside the US. An era analysis of US cases from 1987-2000 showed a progressive improvement in outcome (p < 0.04), with pancreas transplant graft survival rates (GSRs) going from 72% to 82% at one year for SPK cases, from 52% to 74% for PAK cases, and from 47% to 76% for PTA cases. The improvements were due both to decreases in technical failure (TF) rates (overall from 16% to 7%) and immunological failure rates (going from 8% to 2% for SPK, from 27% to 6% for PAK, and from 37% to 12% for PTA cases). The proportion of recipients > 45 years old increased from 5% to 25%, and the improved outcomes encompassed the older patients as well. In patients > 45 years old, SPK pancreas GSRs at one year increased from 62% to 78% (p < 0.002). Pancreas GSRs were also similar for recipients reported to have Type 1 or Type 2 diabetes (at one year, 84% and 83%, respectively for 1996-2000 SPK transplants), the latter designated in 3% of the recipients. Contemporary pancreas transplant outcomes were calculated separately for 1996-2000 US and non-US cases. US patient survival rates at one year were > or = 94% in each recipient category, with one-year pancreas GSRs of 84% for SPK (n = 3,697), 76% for PAK (n = 696), and 71% for PTA (n = 300) (p = 0.0001). The immunological graft failure rates for 1996-2000 US SPK, PAK and PTA cases were 2%, 6%, and 8% at one year (p = 0.001). There was a progressive increase in the use of ED (as opposed to BD) for duct management, to > 50% for 1996-2000 US SPK transplants. Approximately 20% of US SPK ED transplants had venous drainage via the portal system. Pancreas GSRs were not significantly different for 1996-2000 ED (n = 1,940) and BD (n = 1,541) US SPK transplants (83% and 84%, respectively, at one year), nor was there a difference in pancreas GSRs for systemic (n = 1,509) versus portal (n = 411) venous drained ED SPK transplants (83% for both at one year). Kidney GSRs were also not significantly different for ED versus BD US SPK cases, 93% versus 91% at one year (p = 0.13). Duct management did matter for solitary (PAK and PTA) pancreas transplants (P < or = 0.07). Pancreas GSRs for PAK recipients were 77% at one year for BD (n = 359) versus 67% for ED (n = 306) US transplants; for PTA 75% (n = 174) versus 63%. However, BD transplants were associated with a 12% conversion rate to ED by 2 years after transplantation. Analyses of outcome by immunosuppression for US cases showed pancreas GSRs ranged from 77% to 88% at one year, but were highest in SPK recipients given anti-T-cell agents for induction and CSA-MMF for maintenance immunosuppression. For PAK and PTA recipients, those given anti-T-cell agents for induction and TAC-MMF for maintenance immunosuppression had the highest GSRs: 78% and 78%, respectively, at one year for BD pancreas transplants (vs. 85% in BD SPK recipients similarly immunosuppressed, P > 0.08). In regard to non-US cases, the overwhelming majority were in the SPK category (n = 676 for 1996-2000), with a one-year pancreas GSR of 84%, not significantly different than for US cases. In summary, pancreas transplant graft survival rates were > 70% in the solitary (PAK and PTA) and > 80% in SPK recipients during the last 4 years of the 20th century. These outcomes culminate a third of a century of application for the treatment of diabetes mellitus.
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PMID:Pancreas transplant outcomes for United States (US) cases reported to the United Network for Organ Sharing (UNOS) and non-US cases reported to the International Pancreas Transplant Registry (IPTR) as of October, 2000. 1151 58

As of October 10, 2001, > 17,000 pancreas transplant had been reported to the IPTR, > 11,500 in the US and > 4,700 outside the US. An era analysis of US cases from 1987 to 2001 showed a progressive improvement in outcome (p < 0.04), with pancreas transplant graft survival rates (GSRs) going from 75% to 83% at one year for SPK cases, from 50% to 78% for PAK cases, and from 49% to 78% for PTA cases. The improvements were due both to decreases in technical failure (TF) rates (from 14% to 7% in SPK, 23% to 8% in PAK, and 23% to 10% in PTA) and immunological failure rates (going from 7% to 2% for SPK, from 25% to 2% for PAK, and from 28% to 4% for PTA cases). The proportion of recipients > 45 years old increased from 5% to 25%, and the improved outcomes encompassed the older patients as well. In patients > 45 years old, SPK pancreas GSRs at one year increased from 74% to 80% (p < 0.007). Pancreas GSRs were also similar for recipients reported to have Type 1 or Type 2 diabetes (at one year, 84% and 83%, respectively for 1997-2001 SPK transplants), the latter designated in 5% of the recipients. Contemporary pancreas transplant outcomes were calculated separately for 1997-2001 US and non-US cases. US patient survival rates at one year were > or = 95% in each recipient category, with one year pancreas GSRs of 83% for SPK (n = 3885), 79% for PAK (n = 630), and 78% for PTA (n = 240) (p = 0.0002). The immunological graft failure rates for 1997-2001 US SPK, PAK and PTA cases were 4%, 6%, and 8% at one year (p = 0.0001). There was a progressive increase in the use of ED (as opposed to BD) for duct management, to 67% for 1997-2001 US SPK transplants, 51% for PAK and 42% for PTA. Of US SPK ED transplants, 22% had venous drainage via the portal system. US pancreas GSRs were not significantly different for 1997-2001 ED (n = 2,519) and BD (n = 1,260) US SPK transplants (82% and 85%, respectively, at one year), nor was there a difference in pancreas GSRs for systemic (n = 1,958) versus portal (n = 557) venous-drained ED SPK transplants (82% vs. 84% at one year). Kidney GSRs were slightly higher for ED versus BD US SPK cases, 93% versus 91% at one year (p = 0.03). Duct management did matter for solitary (PAK and PTA) pancreas transplants. Pancreas GSRs for PAK recipients were 85% at one year for BD (n = 316) versus 74% for ED (n = 303) US transplants (p < 0.02); for PTA 81% (n = 168) versus 74% (p > or = 0.37). However, BD transplants were associated with a 12% conversion rate to ED by two years posttransplant. Recipient age made little difference for outcome in any category. Indeed, in the PTA category GSRs were significantly higher for US recipients > 45 years old (n = 66) than 21-45 years old (n = 216), 85% versus 77% at 1 year (p < or = 0.10). TAC + MMF was the dominant maintenance immunosuppressant for 1999-2001 US cases (> 70%). In an analysis of outcome according to type of anti-T-cell antibody agents (depleting vs. non-depleting vs. none) for induction therapy in TAC + MMF treated recipients, there were no differences in GSRs in any of the categories. In regard to non-US cases, the overwhelming majority were in the SPK category (n = 1,649 for 1997-2001), with a one year pancreas GSR of 82%, not significantly different than for US cases. In summary, pancreas transplant graft survival rates were nearly 80% at one year in recipients of solitary (PAK and PTA) pancreas transplants, and > 80% in SPK recipients for 1997-2001 cases. The outcome continues to improve as increasing numbers of solitary pancreas transplants are done.
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PMID:Analysis of United States (US) and non-US pancreas transplants reported to the United network for organ sharing (UNOS) and the international pancreas transplant registry (IPTR) as of October 2001. 1221 99

BACKGROUND: The incidence and risk factors for diabetic ketoacidosis (diabetic ketoacidosis) and hyperglycemic hyperosmolar syndrome (hyperglycemic hyperosmolar syndrome, previously called non-ketotic hyperosmolar coma) have not been reported in a national population of renal transplant (renal transplantation) recipients. METHODS: We performed a historical cohort study of 39,628 renal transplantation recipients in the United States Renal Data System between 1 July 1994 and 30 June 1998, followed until 31 Dec 1999. Outcomes were hospitalizations for a primary diagnosis of diabetic ketoacidosis (ICD-9 code 250.1x) and hyperglycemic hyperosmolar syndrome (code 250.2x). Cox Regression analysis was used to calculate adjusted hazard ratios for time to hospitalization for diabetic ketoacidosis or hyperglycemic hyperosmolar syndrome. RESULTS: The incidence of diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome were 33.2/1000 person years (PY) and 2.7/1000 PY respectively for recipients with a prior diagnosis of diabetes mellitus (DM), and 2.0/1000 PY and 1.1/1000 PY in patients without DM. In Cox Regression analysis, African Americans (AHR, 2.71, 95 %CI, 1.96-3.75), females, recipients of cadaver kidneys, patients age 33-44 (vs. >55), more recent year of transplant, and patients with maintenance TAC (tacrolimus, vs. cyclosporine) had significantly higher risk of diabetic ketoacidosis. However, the rate of diabetic ketoacidosis decreased more over time in TAC users than overall. Risk factors for hyperglycemic hyperosmolar syndrome were similar except for the significance of positive recipient hepatitis C serology and non-significance of female gender. Both diabetic ketoacidosis (AHR, 2.44, 95% CI, 2.10-2.85, p < 0.0001) and hyperglycemic hyperosmolar syndrome (AHR 1.87, 95% CI, 1.22-2.88, p = 0.004) were independently associated with increased mortality. CONCLUSIONS: We conclude that diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome were associated with increased risk of mortality and were not uncommon after renal transplantation. High-risk groups were identified.
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PMID:Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome after renal transplantation in the United States. 1265 45

As of October 10, 2002, nearly 19,000 pancreas transplants had been reported to the IPTR, approximately 14,000 in the US and approximately 5,000 outside the US. An era analysis of US cases from 1987-2002 showed a progressive improvement in outcome (p < 0.04), with pancreas transplant graft survival rates (GSRs) going from 75% at one year for 1988-89 to 85% for 2000-2001 SPK cases, from 53% to 77% for PAK cases, and from 48% to 73% for PTA cases. The improvements were due both to decreases in technical failure (TF) rates (from 16% to 8% in SPK, 16% to 9% in PAK, and 19% to 13% in PTA) and immunological failure rates (going from 5% to 2% for SPK, from 27% to 6% for PAK, and from 37% to 9% for PTA cases). The proportion of recipients > 45 years old increased from 9-11% for 1987-92 to 25-30% for 1999-2002 cases, and the improved outcomes encompassed the older patients as well. Contemporary pancreas transplant outcomes were calculated separately for 1996-2002 US and non-US cases. The results of the US analysis are summarized first. US patient survival rates at one year were > or = 94% in each recipient category, with one-year primary pancreas GSRs of 84% for SPK (n = 5.784), 76% for PAK (n = 1,033), and 77% for PTA (n = 470) (p < 0.0001). The immunological graft failure rates for 1996-2002 technically successful SPK, PAK and PTA cases were 2% (n = 5,231), 7% (n = 907), and 8% (n = 404) at one year (p = 0.0001). There was a progressive increase in the use of ED as opposed to BD) for duct management. For 1996-2002 US primary pancreas transplants, ED was used in 65% of SPK, 50% of PAK and 46% for PTA cases. Of the ED transplants, venous drainage via the portal system was used for 23% or SPK, 27% of PAK and 43% of PTA cases. Pancreas GSRs were not significantly different for 1996-2002 ED (n = 3,708) and BD (n = 1,942) SPK transplants (84% and 85%, respectively, at one year), nor was there a difference in pancreas GSRs for systemic (n = 2,859) versus portal (n = 842) venous drained ED SPK transplants (84% vs. 85% at one year). Kidney GSRs were slightly higher for ED versus BD SPK cases, 92% versus 90% at one year (p < 0.003). Pancreas GSRs for PAK transplants were 80% at one year for BD (n = 495; all systemic venous drainage) versus 72% for ED with systemic (n = 357) versus 71% for ED with portal (n = 134) venous drainage (p = 0.004 overall, but p = ns for ED portal vs. systemic). For PTA cases, one-year GSRs were 78% with BD (n = 240; all systemic venous drainage) versus 70% for ED with systemic (n = 115) versus 81% for ED with portal (n = 88) venous drainage (p = 0.2 overall, and 0.09 for ED portal vs. ED systemic). BD transplants were associated with a 12% conversion rate to ED by 2 years posttransplant in all 3 recipient categories. The age of US pancreas transplant recipients made little difference for outcome in the SPK category, with one-year pancreas GSRs ranging from 82% to 85% for patients grouped by age in decades from 10-19 to 60-69 years. In the PAK category, one-year GSRs progressively increased with each decade of age, going from 69% for those 20-29 to 83% for those 60-69 years old. Likewise, in the PTA category one-year GSRs increased with each decade of age, going from 41% for the 10-19 to 65% for the 20-29 to 76% for the 30-39 to 83% for the 40-49 to 85% for the 60-69 year old recipients. Pancreas GSRs were identical (84% at one year) for 1996-2002 US SPK recipients reported to have Type 1 (n = 5,356) or Type 2 (n = 288) diabetes (5% classified as Type 2). TAC+MMF was the dominant maintenance immunosuppressant for 1996-2002 US cases (approximately 60%), and with this regimen one-year GSRs were > or = 80% in all 3 recipient categories. An analysis of GSRs according to type of anti-T-cell antibody agents (depleting vs. non-depleting vs. none) for induction therapy in TAC+MMF treated recipients did not detect significant differences in any of the categories. The absolute numbers and the proportions of US pancreas grafts that were retransplants in the SPK and PTA categories (1% and 10% respectively) were relatively small, while a large number of the PAK grafts were retransplants (n = 346; 32% of the total). The majority of the latter were done after isolated failure of a pancreas graft in SPK recipients. In the SPK (n = 78) and PTA (n = 53) categories, the retransplant GSRs were significantly (p --> 0.06) lower than those for primary transplants. In the PAK category, however, GSRs were not significantly different (p = 0.14) for retransplant versus primary cases (72% and 76%, respectively, at one year). Known causes of death in 1996-2002 US pancreas recipients were tabulated for each category. Most were from cardio-cerebro-vascular accidents (1.3-2.6% incidence) or from infections (1.2-1.4% incidence), while death from malignancy or PTLD was reported in < or = 0.6% of recipients. In regard to non-US pancreas transplants, the overwhelming majority were in the SPK category (n = 2,163 for 1996-2002), with one-year patient, kidney and pancreas survival rates of 96%, 91% and 85% as good or better than the outcomes for US cases. In summary, with modern immunosuppression (TAC + MMF for maintenance) 1996-2002 pancreas transplant graft survival rates were > or = 80% at one year in all categories of recipients (SPK, PAK, PTA). The solitary pancreas transplant outcomes continue to improve as more are done.
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PMID:Pancreas transplant outcomes for United States (US) and non-US cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR) as of October 2002. 1297 36

As of December 31, 2003, more than 21,000 pancreas transplants had been reported to the IPTR, >15,000 in the US and >5,000 outside the US. An era analysis of US cases from 1987 to May 15, 2003 showed a progressive improvement in outcome (p<0.04), with pancreas transplant graft survival rates (GSRs) going from 76% at one year for 1987-92 to 85% for 2001-2003 SPK cases, from 57%-79% for PAK cases, and from 55%-76% for PTA cases. The improvements were due both to decreases in technical failure rates (from 15%-10% in SPK, 21%-13% in PAK, and 24%-8% in PTA) and immunological failure rates (going from 6%-1% for SPK, from 23%-4% for PAK, and from 28%-7% for PTA cases). The proportion of recipients >45 years old increased from 11% in all 3 recipient categories in 1987-92 to 32-36% for 2001-2003 cases, and the improved outcomes encompassed the older patients as well. Contemporary pancreas transplant outcomes were calculated separately for January 1, 1999- May 15, 2003 US and non-US cases. The results of the US analysis are summarized first. US patient survival rates at one year were >95% in each recipient category, with one-year primary pancreas GSRs of 85% for SPK (n=3,775), 79% for PAK (n=951), and 78% for PTA (n=403) (p<0.0001). The immunological graft failure rates for 1996-2002 technically successful SPK, PAK and PTA cases were 2% (n=3,437), 5% (n=854), and 7% (n=356) at one year (p=0.0001). There was a progressive increase in the use of ED (as opposed to BD) for duct management. For 1999-2003 US primary pancreas transplants, ED was used in 78% of SPK, 60% of PAK and 49% for PTA cases. Of the ED transplants, venous drainage via the portal system was used for 23% of SPK, 27% of PAK and 44% of PTA cases. Pancreas GSRs were nearly identical for 1999-2003 ED (n=2,898) and BD (n=798) SPK transplants (85% for both at one year), nor was there a significant difference (p>0.17) in pancreas GSRs for systemic (n=2,218) versus portal (n=680) venous drained ED SPK transplants (84% vs 87% at one year). Kidney GSRs were not significantly different for ED versus BD SPK cases, 93% and 92% at one year (p=0.24). Pancreas GSRs for PAK transplants were 82% at one year for BD (n=360; all systemic venous drainage) versus 77% for ED with systemic (n=398) versus 74% for ED with portal (n=150) venous drainage (p=0.03 overall, and 0.02 for ED portal vs ED systemic). For PTA cases, one-year GSRs were 81% with BD (n=196; all systemic venous drainage) versus 69% for ED with systemic (n=99) versus 80% for ED with portal (n=90) venous drainage (p > or = 0.08 overall, and 0.11 for ED portal vs ED systemic). BD transplants were associated with a 12-14% conversion rate to ED by 2 years after transplantation in the 3 recipient categories. The age of US pancreas transplant recipients made little difference for outcome in the SPK category, with one-year pancreas GSRs ranging from 80-85% for patients grouped by age in decades from 10-19 to 60-69 years. In the PAK category, one-year GSRs tended to increase with age, going from 71% for those 20-29 to 89% for those 60-69 years old. Likewise, in the PTA category one-year GSRs were higher in older than younger donors, age, being only 50% in 10-19 year-old and 87% in 40-49 year-old recipients. Pancreas GSRs were identical (85% at one year) for 1999-2003 US SPK recipients reported to have Type 1 (n=3,479) or Type 2 (n=231) diabetes (6% classified as Type 2). TAC+MMF was the dominant maintenance immunosuppressant for 1999-2003 US cases (approximately two-thirds) and with this regime one-year GSRs were >81% in all 3 recipient categories. The results were very similar (> or = 79% one-year GSR) in patients (approximately 10%) treated with sirolimus under various protocols. HLA-B locus matching had a significant effect on pancreas transplant outcome in the PTA category. For 1999-2003 cases the one-year rejection loss rate was 15% in recipients mismatched for 2 B-locus antigens (n=28) versus 3% and 4% for those mismatched for one (n=114) or zero (n=82) antigens. The proportion of 1999-2003 US pancreas grafts that were retransplants was <2% in the SPK and only 9% in the PTA categories, but 23% in the PAK category. The majority of the latter were done after isolated failure of a pancreas graft in SPK recipients. Pancreas retransplant GSRs at one year were 69% in the SPK (n=60), 77% in the PAK (n=288) and 73% in the PTA (n=39) categories, significantly lower than for primary grafts only in the SPK category (p=0.001). In regard to non-US pancreas transplants, even in 1999-2003 the overwhelming majority were in the SPK category (n=1,833), with one-year patient, kidney and pancreas survival rates of 98%, 94% and 89%, slightly but significantly higher than those for US cases done during the same period. Non-US PAK (n=55) GSR at one year was 88%, similar to that for US cases done during this period, but the non-US PTA (n=80) GSR at one year was lower at 66%. In summary, with modern immunosuppression (TAC + MMF for maintenance) 1999-2003 US pancreas transplant graft survival rates were > or = 80% at one year in all categories of recipients (SPK, PAK, PTA), as was the case for non-US SPK and PAK transplants.
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PMID:Pancreas transplant outcomes for United States (US) and non-US cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR) as of May 2003. 1538 96

Aim of the present study was to assess, in a pair-matched analysis design, risk factors for post-transplant diabetes mellitus (PTDM) in renal transplant recipients (KTx). The incidence of PTDM was evaluated in 538 consecutive KTx in relation to their baseline immunosuppression. PTDM was defined according to the 2003 American Diabetes Association and World Health Organization experts committee definition. As risk factors for PTDM development were considered: age, family history of diabetes, body mass index (BMI), baseline immunosuppression, doses and blood levels of the immunosuppressive agents used. Baseline immunosuppression consisted of CSA, TAC and SRL + CNI. Thirty-two pair-matched controls were identified among the 538 KTx and included in the risk analysis. Significant risk factors for the development of PTDM were identified in the family history of diabetes (P < 0.02) and BMI (P < 0.05). Higher BMI and positive family history for diabetes mellitus were significant risk factors for the development of PTDM, regardless of the immunosuppressive agent used.
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PMID:Post-transplant diabetes mellitus: a case-control analysis of the risk factors. 1573 Apr 91


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