Pankreastransplantation

Zusammenfassung

Die Pankreastransplantation stellt die einzige Therapieoption für Patienten mit Typ-I-Diabetes-mellitus mit völliger Insulinunabhängigkeit und Normalisierung des Hba1c Spiegels dar. Fortschritte auf dem Gebiet der Organpräservation, chirurgischen Technik sowie der prophylaktischen Immunosuppression führten zu einer signifikanten Verbesserung des Transplantatüberlebens nach solitärer Pankreas- und kombinierter Nieren-Pankreastransplantation und daraus resultierend, zu einer deutlichen Zunahme der Transplantationszahlen weltweit. Die enterische Drainage des Pankreassaftes zusammen mit systemischer oder portalvenöser endokriner Ableitung wird von der Mehrzahl der Zentren nach kombinierter Nieren-Pankreastransplantation bevorzugt. Der Eingriff erfordert in bis zu 25 % Reinterventionen wegen Thrombosen der Transplantatgefäße, Nachblutungen, Pankreatitis und Lecks im Bereich des Spender-Duodenalsegmentes mit intraabdominellen Infektionen (IAI) und Sepsis.

Abstract

Pancreas transplantation has evolved as the only treatment modality for patients with type 1 diabetes mellitus restoring complete insulin independence and normalization of HbA1c values. The tremendous improvement in graft outcome after simultaneous pancreas kidney transplantation (SPK) and solitary pancreas transplantation (PTA) was mainly achieved by progress in the field of organ preservation and a reduction of technical failures together with better immunosuppression. The majority of transplant centers presently use enteric drainage (ED) for the diversion of the pancreatic juice in combination with either systemic or portal endocrine drainage after SPK. Indications for reinterventions include thrombosis of graft vessels, bleeding, graft pancreatitis and intraabdominal infections due to leaks at the site of exocrine drainage.

Schlüsselwörter

Pankreastransplantation - Indikationen - Technik - Ergebnisse - chirurgische Komplikationen

Key words

Pancreas transplantation - indications - technique - results - surgical complications

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