Living Related Pancreas Transplantation Alone With Enteric Drainage in Japan

Case Report

Y. Sato, H. Nakatsuka, S. Yamamoto, H. Oya, T. Kobayashi, T. Watanabe, H. Kokai, Takashi Kenmochi, K. Hatakeyama

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

In this study, we report a living donor partial pancreas transplantation using intraportal donor-specific leukocyte transfusion (DSLT). The recipient was a 38-year-old woman who had type I diabetes mellitus for 17 years. Hypoglycemia occurred 2 or 3 times per week. Her hemoglobin A1c level was 9.0%, and she required 70 U of insulin almost every day. The donor was her 64-year-old father. The steroid-minimized immunosuppressive protocol included 1.5mg of thymoglobulin administered with a steroid bolus on days 0, 4, and 7 postoperatively. Steroids were never prescribed thereafter. Postoperative maintenance therapy included tacrolimus (FK506) and mycophenolate mofetil. In addition to these conventional approarches, we administered intraportal DSLT on days 0, 1, 4, and 7 after transplantation. The donor-specific leukocytes (40mL) had been separated from donor whole blood using an apheresis filter (Cellsorba EX; Asahi Kasei medical Co, Ltd, Tokyo, Japan). In the recipient operation, a segmental pancreas graft was transplanted into the right iliac cavity with enteric drainage with a pancreatic duct stent. Operation time was 6 hours. The postoperative course was uneventful. The patient was discharged on day 15 after transplantation. There was no acute rejection for six months after transplantation. The hemoglobin A1c level recovered to 5.1% with 6 U of insulin per day. At immunologic analysis, only interleukine-10 cytokine production was elevated at 7 days after transplantation. At flow cytometry cross-match analysis, the immunoglobulin M antibody decreased from day 7 after transplantation. We conclude that intraportal DSLT may be an effective adjunct to a steroid-free regimen.

Original languageEnglish
Pages (from-to)2559-2561
Number of pages3
JournalTransplantation Proceedings
Volume40
Issue number8
DOIs
Publication statusPublished - 01-10-2008

Fingerprint

Pancreas Transplantation
Leukocyte Transfusion
Drainage
Japan
Transplantation
Tissue Donors
Steroids
Tacrolimus
Hemoglobins
Insulin
Mycophenolic Acid
Blood Component Removal
Tokyo
Living Donors
Pancreatic Ducts
Immunosuppressive Agents
Blood Donors
Type 1 Diabetes Mellitus
Hypoglycemia
Fathers

All Science Journal Classification (ASJC) codes

  • Surgery
  • Transplantation

Cite this

Sato, Y., Nakatsuka, H., Yamamoto, S., Oya, H., Kobayashi, T., Watanabe, T., ... Hatakeyama, K. (2008). Living Related Pancreas Transplantation Alone With Enteric Drainage in Japan: Case Report. Transplantation Proceedings, 40(8), 2559-2561. https://doi.org/10.1016/j.transproceed.2008.08.052
Sato, Y. ; Nakatsuka, H. ; Yamamoto, S. ; Oya, H. ; Kobayashi, T. ; Watanabe, T. ; Kokai, H. ; Kenmochi, Takashi ; Hatakeyama, K. / Living Related Pancreas Transplantation Alone With Enteric Drainage in Japan : Case Report. In: Transplantation Proceedings. 2008 ; Vol. 40, No. 8. pp. 2559-2561.
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Sato, Y, Nakatsuka, H, Yamamoto, S, Oya, H, Kobayashi, T, Watanabe, T, Kokai, H, Kenmochi, T & Hatakeyama, K 2008, 'Living Related Pancreas Transplantation Alone With Enteric Drainage in Japan: Case Report', Transplantation Proceedings, vol. 40, no. 8, pp. 2559-2561. https://doi.org/10.1016/j.transproceed.2008.08.052

Living Related Pancreas Transplantation Alone With Enteric Drainage in Japan : Case Report. / Sato, Y.; Nakatsuka, H.; Yamamoto, S.; Oya, H.; Kobayashi, T.; Watanabe, T.; Kokai, H.; Kenmochi, Takashi; Hatakeyama, K.

In: Transplantation Proceedings, Vol. 40, No. 8, 01.10.2008, p. 2559-2561.

Research output: Contribution to journalArticle

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AU - Sato, Y.

AU - Nakatsuka, H.

AU - Yamamoto, S.

AU - Oya, H.

AU - Kobayashi, T.

AU - Watanabe, T.

AU - Kokai, H.

AU - Kenmochi, Takashi

AU - Hatakeyama, K.

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Y1 - 2008/10/1

N2 - In this study, we report a living donor partial pancreas transplantation using intraportal donor-specific leukocyte transfusion (DSLT). The recipient was a 38-year-old woman who had type I diabetes mellitus for 17 years. Hypoglycemia occurred 2 or 3 times per week. Her hemoglobin A1c level was 9.0%, and she required 70 U of insulin almost every day. The donor was her 64-year-old father. The steroid-minimized immunosuppressive protocol included 1.5mg of thymoglobulin administered with a steroid bolus on days 0, 4, and 7 postoperatively. Steroids were never prescribed thereafter. Postoperative maintenance therapy included tacrolimus (FK506) and mycophenolate mofetil. In addition to these conventional approarches, we administered intraportal DSLT on days 0, 1, 4, and 7 after transplantation. The donor-specific leukocytes (40mL) had been separated from donor whole blood using an apheresis filter (Cellsorba EX; Asahi Kasei medical Co, Ltd, Tokyo, Japan). In the recipient operation, a segmental pancreas graft was transplanted into the right iliac cavity with enteric drainage with a pancreatic duct stent. Operation time was 6 hours. The postoperative course was uneventful. The patient was discharged on day 15 after transplantation. There was no acute rejection for six months after transplantation. The hemoglobin A1c level recovered to 5.1% with 6 U of insulin per day. At immunologic analysis, only interleukine-10 cytokine production was elevated at 7 days after transplantation. At flow cytometry cross-match analysis, the immunoglobulin M antibody decreased from day 7 after transplantation. We conclude that intraportal DSLT may be an effective adjunct to a steroid-free regimen.

AB - In this study, we report a living donor partial pancreas transplantation using intraportal donor-specific leukocyte transfusion (DSLT). The recipient was a 38-year-old woman who had type I diabetes mellitus for 17 years. Hypoglycemia occurred 2 or 3 times per week. Her hemoglobin A1c level was 9.0%, and she required 70 U of insulin almost every day. The donor was her 64-year-old father. The steroid-minimized immunosuppressive protocol included 1.5mg of thymoglobulin administered with a steroid bolus on days 0, 4, and 7 postoperatively. Steroids were never prescribed thereafter. Postoperative maintenance therapy included tacrolimus (FK506) and mycophenolate mofetil. In addition to these conventional approarches, we administered intraportal DSLT on days 0, 1, 4, and 7 after transplantation. The donor-specific leukocytes (40mL) had been separated from donor whole blood using an apheresis filter (Cellsorba EX; Asahi Kasei medical Co, Ltd, Tokyo, Japan). In the recipient operation, a segmental pancreas graft was transplanted into the right iliac cavity with enteric drainage with a pancreatic duct stent. Operation time was 6 hours. The postoperative course was uneventful. The patient was discharged on day 15 after transplantation. There was no acute rejection for six months after transplantation. The hemoglobin A1c level recovered to 5.1% with 6 U of insulin per day. At immunologic analysis, only interleukine-10 cytokine production was elevated at 7 days after transplantation. At flow cytometry cross-match analysis, the immunoglobulin M antibody decreased from day 7 after transplantation. We conclude that intraportal DSLT may be an effective adjunct to a steroid-free regimen.

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