Professor Ugo Boggi of the University of Pisa has given an update on pancreatic transplantation, arguing that an immediately vascularised pancreaticoduodenal graft is the only therapy that reproducibly induces insulin independence in beta cell deficient diabetic patients.
“Because of the surgical risk associated with transplanation and the lifelong need for immunosuppression, pancreas transplantation is an option only for selected patients with insulin dependent diabetes: namely type 1 diabetes and in lean patients with type 2 diabetes when the level of insulin secretion is very low.”
This procedure may be considered as a group of three separate clinical entities: simultaneous pancreas and kidney transplantation (SPK), pancreas after kidney (PAK), and pancreas transplant alone (PTA). SPK is highly recommended in patients with insulin-dependent diabetes and end-stage renal failure, since in this group of patients this procedure is considered life-saving, like liver transplant in cirrhotic patients. The role of PAK and PTA is less defined, because of the lack of end-stage renal disease, but evidence is emerging that sustained insulin independence not only enhances the quality of life of these patients, but also improves the function of vital organs such as the heart or the kidneys. In the long term, also PAK and PTA could prove life-saving in selected diabetic patients.
Professor Boggi said: “A recent breakthrough in pancreas transplantation is the possibility of performing this formidable procedure through a minimally invasive approach (laparoscopy) using robotic assistance (da Vinci Surgical System). The advantages of a minimally invasive approach in pancreas transplantation have not been fully defined yet, but the possibility to significantly reduce surgical trauma removes one of the historical disincentives to pancreas transplantation.”
The greatest current challenge remains donor shortage. Pancreas transplanation requires young (≤ 40yr) donors who, ideally, died because of head trauma. Other selection criteria apply, making “pancreas donor” extremely rare, as the donor population is ageing and most donor are aged over 60 and have concurrent diseases including diabetes. “Optimal use of all available donors is crucial,” concluded Professor Boggi. “Protocols for national and international sharing of suitable donors are key, not only to address organ shortage but also because pancreas transplantaton is associated with a steep learning curve that makes center and surgeon volume of extreme importance to the success of this operation.”
Ugo Boggi, MD, FEBS, is Professor of Surgery at the University of Pisa (Italy) and Adjunct Associate Professor of Surgery at the University of Pittsburgh (USA). In the year 2014 Dr. Boggi was Visiting Professor in Surgery in Robotic hepatobiliary surgery at the the Beth Israel Deaconess Medical Center (Harvard Medical School, Boston, MA, USA). At the University of Pisa, Dr. Boggi heads the Division of the General and Transplant Surgery.
Dr. Boggi is a world-renowned, gastrointestinal and transplant surgeon
with a strong expertise in the surgical treatment of hepato-biliary and pancreatic cancers as well as in pancreas and renal transplantation. Dr. Boggi practices state-of-the-art robotic surgery having performed the first world robotic pancreas transplant and the first world robotic distal selective spleno-renal shunt for the treatment of severe portal hypertension. Dr. Boggi has one of the world’s largest experiences in robotic pancreatic surgery, including robotic pancreatoduodenectomy.
Dr. Boggi published over 260 peer-reviewed articles, 50 book chapters, and one book. He is member of the Editorial Board of six international scientific journals and servers as a reviewer for twenty-eight international scientific journals. Dr. Boggi is member of National and International Surgical Societies and was member of the organizing committee of the IHPBA State of the Art Conference on Minimally Invasive Pancreatic Resection held in São Paulo (Brazil) on April 20, 2016.
Source EASD 2016