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Query: UMLS:C0030305 (pancreatitis)
 16,014 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To study the degree of protease activation at reperfusion of a pancreatic allograft after cold storage for 24 hr, 18 porcine whole-organ pancreaticoduodenal allograft transplantations were performed. Twelve grafts were flushed with and stored in Perfadex. In six of these, a hyperosmotic salt solution was injected into the graft aorta at reperfusion. Six grafts were flushed and stored in UW solution. Eleven of twelve grafts in the Perfadex groups were functioning on the first postoperative day, compared with one of six in the UW solution group. There was a significantly more pronounced protease activation among grafts stored in UW solution than in the other groups, with a subsequent breakthrough of the local protease protection barrier made up of protease inhibitors. In surviving pigs (n = 14), biochemical signs of protease activation evolved in plasma, including formation of trypsin-protease inhibitor complexes, a decline in C3 and kininogen levels, and a decline in functionally active alpha 2-macroglobulin, functionally active antithrombin III, and plasma kallikrein inhibitory activity. These biochemical signs of pancreatitis correlated with a deteriorated graft function on the second postoperative day, indicating that graft tissue damage occurred due to protease activation.
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PMID:Protease activation following reperfusion of porcine pancreatic allografts. 127 75

Assessment of viability of a pancreas graft during preservation is very important to avoid transplantation of a nonfunctioning allograft. In the present report the correlation between adenosine triphosphate tissue concentration at the end of cold preservation by the two-layer method and viability a of canine pancreas graft following transplantation was studied. After preservation by an original two-layer (Euro-Collins' solution/perfluorochemical) method (group 1) and a modified two-layer (University of Wisconsin solution/PFC) method (group 2) for 24, 48, 72, 96, and 120 hr (subgroups A, B, C, D, and E), the tissue concentration of ATP was determined using high-performance liquid chromatography, and the viability of the pancreas graft was tested in the canine model of segmental pancreas autotransplantation. Maintenance of normoglycemia for at least five days after transplantation was considered to indicate a viable pancreas graft. In group 1, functional success rates were A: 5/5, (100%), B: 4/4 (100%), C: 4/4, (100%), and D: 0/4 (0%), respectively. The ATP tissue concentrations were 7.47 +/- 0.47 (n = 5), 7.91 +/- 1.21 (n = 4), 8.29 +/- 0.21 (n = 4), and 4.94 +/- 1.11 (n = 4) mumol/g dry weight in groups 1A, 1B, 1C, and 1D, respectively. There was a statistically significant difference between viable groups (groups 1A, 1B, and 1C, 7.86 +/- 0.77 mumol/g dry weight [n = 13]) and the nonviable group (group D, 4.94 +/- 1.11 mumol/g dry weight (n = 4) (P less than 0.01). On the other hand, the functional success rates were 3/3 (100%), 3/3 (100%), 3/3 (100%), 5/7 (71%), and 0/3 (0%) in groups 2A, 2B, 2C, 2D, and 2E, respectively. Two of seven dogs died of causes related to the grafts (pancreatitis and thrombosis). The ATP tissue concentrations were 8.53 +/- 1.45 (n = 3), 9.64 +/- 1.77 (n = 3), 13.81 +/- 2.09 (n = 3), and 12.49 +/- 2.52 (n = 5) mumol/g dry weight in groups 2A, 2B, and 2C and in viable grafts in group 2D, respectively, but the ATP tissue concentration of nonviable grafts in group 2D and group E were 3.51 +/- 0.81 (n = 2) and 3.98 +/- 1.34 (n = 3) mumol/g dry weight, respectively. There was a statistically significant difference between viable groups (groups 2A, 2B, 2C and viable grafts in group 2D, 11.03 +/- 2.72 mumol/g dry weight [n = 14]) and nonviable groups (group E and nonviable grafts in group 2D, 3.79 +/- 1.06 mumol/g dry weight [n = 5]) (P less than 0.01).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Correlation between high adenosine triphosphate tissue concentration and good posttransplant outcome for the canine pancreas graft after preservation by the two-layer cold storage method. 175 85

A retrospective analysis of all organs that were preserved with University of Wisconsin solution was undertaken to assess the impact of this solution on early allograft function. From May 1987 until June 1990, 181 livers, 92 pancreata, and 92 kidneys were preserved with University of Wisconsin solution for extended periods of time. The mean (+/- SD) preservation times were as follows: liver, 12.6 +/- 4.5 hours; pancreas, 16.7 +/- 4.4 hours; and kidney, 18.3 +/- 4.3 hours. The overall rate of primary nonfunction and hepatic artery thrombosis were 6.1% and 3.9%, respectively. No differences in the rates of primary nonfunction and hepatic artery thrombosis were noted for combined liver-pancreas procurement vs isolated liver retrievals or when reduced-size liver transplants were compared with nonreduced liver transplants. Likewise, no difference in primary nonfunction or hepatic artery thrombosis was seen in livers that were preserved for less than 6, 6 to 12, and greater than 12 hours. However, serum aminotransferase levels and prothrombin times were lower on the first postoperative day in livers that were preserved for less than 6 hours when compared with 6 to 12 or greater than 12 hours. Early pancreatic allograft function was also excellent for up to 24 hours of cold-storage preservation. All patients were immediately insulin independent, and there were no cases of initial nonfunction or graft pancreatitis. There were only two cases (2.2%) of pancreatic vascular thrombosis in this series. No difference in pancreatic function was noted for organs that were preserved for less than 6, 6 to 12, or greater than 12 hours. Likewise, renal allograft function was excellent, with only two patients (2.2%) requiring postoperative hemodialysis. The actuarial 1-month patient survival for liver and pancreas-kidney transplant recipients was 91.5% and 98.9%, respectively. Actuarial 1-month allograft survival for liver, pancreas, and kidney transplants was 83.0%, 96.7%, and 97.8%, respectively. In conclusion, University of Wisconsin solution represents a significant advancement in cold-storage organ preservation and is ideally suited as a universal intra-abdominal aortic-flush and cold-storage solution.
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PMID:Current status of organ preservation with University of Wisconsin solution. 200 Nov 73

Biochemical signs of pancreatitis in plasma and pancreatic exudates were determined in 22 pigs subjected to pancreatic allograft transplantation after the graft had been in cold storage for 6 hr. Two perfusion and preservation media were used. We found signs of protease activation in the pancreatic exudate during the first hour after reperfusion. The local protease protection barrier was, however, not broken and no plasma changes indicating pancreatitis were seen during this period. On the first and second postoperative days, mild biochemical signs of pancreatitis were seen in the plasma, including a decrease in kininogen and C3 concentration as well as in plasma kallikrein inhibitory activity and the appearance of trypsin-protease inhibitor complexes. No correlation was seen between these biochemical signs of pancreatitis and graft appearance or function, indicating that the reperfusion pancreatitis seen after 6 hr of cold storage is of minor significance. No significant differences were seen between the two preservation media used (Perfadex and EuroCollins solution).
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PMID:Biochemical characterization of reperfusion pancreatitis in porcine pancreatic allografts after six hours of cold storage. 201 26

Normothermic ischemia tolerance is an important aspect of organ procurement and transplantation. The function of pancreas and kidney autografts was investigated in totally pancreatectomized or nephrectomized canine recipients. In 30 dogs the left limb (tail) of the pancreas was removed but left in the abdominal cavity after cessation of blood flow to produce warm ischemia for 30, 60, and 120 min (10 dogs at each time point), and then was flushed with cold Ringers' lactate and transplanted to the iliac vessels. Twenty dogs with fresh pancreatic transplants were controls. The success rate of pancreas transplants with warm ischemia of 1/2 and 1 hr was the same as that of controls (80%); however, after 1 hr normothermia 5/10 dogs had episodes of hyperglycemia for 1 week before glucose levels came back to normal. All but one graft with 2 hr warm ischemia failed. Intravenous glucose tolerance test (IVGTT) mean (+/- SEM) K values were not different in the successful groups, i.e., no warm ischemia: -1.55 +/- 0.15%; 1/2 hr warm ischemia: -1.81 +/- 0.18%; 1 hr warm ischemia: -1.64 +/- 0.09%. Amylase levels increased after transplant with maximum values at Day 2, then returned to normal, but the levels remained elevated in recipients of grafts subjected to longer normothermia with evidence of pancreatitis after 1 hr warm ischemia. Fifteen kidney grafts were treated similarly with warm ischemia exposure of 1/2 hr (n = 9) and 1 hr (n = 6) before being flushed and autotransplanted, and were compared to 16 fresh kidney transplants. After 1/2 hr warm ischemia none of the kidney grafts failed but 78% of the recipients had elevated serum creatinine and urea nitrogen levels which returned slowly to normal after 3 to 4 weeks. There was only one long-term survivor after 1 hr warm ischemia. Thus the pancreas seems to be more resistant to warm ischemia damage than is the kidney. This difference should be taken into consideration in regard to organ procurement for clinical transplantation.
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PMID:Definition of normothermic ischemia limits for kidney and pancreas grafts. 242 97

Fifty-nine pancreatic transplantations have been performed at Huddinge Hospital between May 1974 and October 1985 with a substantial improvement in results over the years. In the most recent series, consisting of 19 combined renal and pancreatic transplantations performed May 1984 to September 1985; the 1-year actuarial patient survival and pancreatic graft survival were 86% and 66% respectively. Thirteen of these grafts are functional presently, at 18 to 2 months, and all such patients are insulin free and exhibit normal metabolic control. Our practice includes drainage of the pancreatic juice to the exterior by means of a pancreatic duct catheter during the first 2-3 postoperative weeks, thereby promoting healing of the pancreatico-enteric anastomosis. Although cold ischemia time was kept low in this series, a moderate graft pancreatitis developed, with a peak serum amylase level of 16.8 + 2.2 ukat/l and a peak amylase activity in the peripancreatic fluid of 280 + 110 ukat/l. The volume of pancreatic juice from the ductal catheter was very low in the first postoperative days but then rose to reach a plateau level of about 500 ml/day. The amylase activity in this juice was very high (9100 + 2500 ukat/l) during the first postoperative day, but then gradually decreased to reach a steady level around 3000 ukat/l after 4-7 days.
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PMID:Segmental pancreatic transplantation in Stockholm. 243 84

Nineteen combined renal and segmental pancreatic transplantations with enteric exocrine diversion were performed between May 1984 and September 1985. The one year actuarial patient survival rate and pancreatic graft survival rate were 86 and 66 per cent, respectively. Thirteen pancreatic grafts are presently functioning (two to seven months) and all of the recipients are insulin-free. Although graft cold ischemia time was kept low (a mean of 4.6 hours), a moderate graft pancreatitis developed with a peak serum amylase level of 16.8 +/- 2.2 microkatal per liter. Analysis of the fluid drained through an abdominal drain tube placed at the graft site revealed an amylase activity of 280 +/- 110 microkatal per liter on the first postoperative day and rapidly decreasing to a mean of 15 +/- 5 microkatal per liter on day 6. A pancreatic duct catheter was used to divert the exocrine juice to the exterior during the first few postoperative weeks thereby promoting healing of the pancreaticoenteric anastomosis. The volume of pancreatic juice from the ductal catheter was quite low in the first postoperative days but then rose to reach a plateau level of 500 to 600 milliliters. The amylase activity and the lipase concentration in the pancreatic juice was very high (9,100 +/- 2,450 microkatal per liter and 11.1 +/- 4.4 grams per liter, respectively) during the first postoperative day but then gradually decreased to reach a steady level after four to seven days. Intravenous administration of secretin induced a sixfold increase in the flow of pancreatic juice. An intravenous infusion of somatostatin significantly reduced the flow of pancreatic juice and the amylase activity and lipase concentration in the juice but did not abolish the secretin induced increase in pancreatic secretion.
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PMID:Studies on the exocrine secretion of segmental pancreatic grafts in humans. 243 63

We have recently reported successful 72-h preservation of the canine pancreas with a new cold-storage solution developed at the University of Wisconsin (UW solution). Over 10 mo, we performed 11 combined pancreas-kidney and 4 isolated-pancreas transplants with this solution. In situ cooling of the donor pancreas was performed with 1000 ml of UW solution followed by ex vivo perfusion with an additional 250-500 ml. Graft preservation times ranged from 3 to 19 h (mean 10.2 h). Pancreas transplants were vascularized whole-organ grafts with pancreaticoduodenocystostomy. Early graft function was excellent as assessed by immediate insulin independence, high urinary amylase and low serum amylase levels, and a technetium perfusion index indicating good pancreatic blood flow. There were no episodes of primary nonfunction, graft pancreatitis, or vascular thrombosis. Actuarial patient and graft survival at 1 mo was 92.9%. We conclude that UW solution provides excellent early graft function for up to 19 h of cold storage. Based on previously reported data on its efficacy in liver and kidney preservation, UW solution seems ideally suited as a universal intra-aortic flush and cold-storage solution.
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PMID:Use of UW solution in pancreas transplantation. 246

In order to investigate pancreatitis caused by cold ischemic damage to pancreatic grafts, an isolated, normothermic, ex vivo perfusion model was employed. Canine pancreases were subjected to 24 and 48 h of cold ischemia and then reperfused. The results showed that cold ischemia results in pancreatitis as measured by weight gain (tissue edema) and elevated leakage of amylase into the perfusate. The addition of allopurinol to the perfusion system did not prevent the signs of pancreatitis. From the results it can be concluded that the isolated, perfused pancreas model in the dog is useful for studying preservation-induced pancreatitis. The absence of any effect of allopurinol treatment suggests that oxygen-free radicals mediated by the xanthine oxidase system is of minor importance for the pathogenesis of postischemic pancreatitis.
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PMID:Preservation-induced pancreatitis in an isolated perfused pancreas model in the dog. 247 41

We have developed a convenient method combining fast protein liquid chromatography (FPLC) with sensitive radioimmunoassay (RIA) for thyrotropin-releasing hormone (TRH) to separate and identify TRH and its metabolite histidyl-proline diketopiperazine (CHP) and applied this to study inactivation of TRH by blood extracts from patients with liver cirrhosis (LC) and acute edematous pancreatitis (AP). Blood samples spiked with TRH and CHP were extracted by cold methanol and injected on a reverse-phase FPLC column. A linear gradient was applied for separation. Subsequent analyses of fractions by RIA for TRH revealed that only fractions 9-10 contained TRH. Separation by retention time (9.9 +/- 0.8 min for TRH, 10.5 +/- 0.6 min for CHP, mean +/- SEM) was highly reproducible. For degradation studies, pooled sera from patients with LC and AP were incubated with TRH and CHP for 60 min. Inactivation of TRH was less rapid in the presence of blood extract from LC patients than that from normal subjects or AP patients. CHP was more stable than TRH. These data suggest that activity of TRH-degrading enzymes is reduced in liver disease, whereas it does not appear to be altered in AP. Degradation of CHP does not closely reflect metabolic processing of its major precursor. This rapid and sensitive method may be applicable for further investigations on the metabolism of TRH in organic fluids.
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PMID:A fast protein liquid chromatography (FPLC) method for study of thyrotropin-releasing hormone (TRH) and its metabolite histidyl-proline diketopiperazine (CHP) in human blood: degradation in liver and pancreatic diseases. 812 15


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