Derivación exocrina al duodeno en trasplante simultáneo de riñón y páncreas, experiencia en la Fundación Valle de Lili, Cali, Colombia
DOI:
https://doi.org/10.30944/20117582.283Palabras clave:
páncreas exocrino, trasplante de riñón, trasplante de páncreas, diabetes mellitus, complicaciones de la diabetes, insuficiencia renal crónicaResumen
Introducción. El trasplante simultáneo de riñón y páncreas es reconocido como un tratamiento eficaz para el manejo de pacientes con diabetes mellitus, principalmente de tipo I, e insuficiencia renal crónica. Sin embargo, hoy en día aún existe dificultad para el seguimiento del injerto pancreático, ya que no existe un marcador serológico definitivo que lo permita y persiste la dificultad para la toma de biopsias. Se ha descrito una modificación en la técnica quirúrgica que permitiría el acceso endoscópico mediante una duodenoduodenostomía.
Materiales y métodos. Se seleccionaron los pacientes que recibieron un trasplante simultáneo de riñón y páncreas con derivación exocrina al duodeno, evaluando la seguridad del procedimiento, la evolución y las complicaciones médico-quirúrgicas.
Resultados. Nueve pacientes fueron sometidos a trasplante simultáneo de riñón y páncreas con derivación exocrina al duodeno. La mediana de la edad fue de 36 años y la mayoría era del sexo masculino. El tiempo de isquemia en frío fue de 10 horas para el injerto pancreático y de 11 horas para el renal. El tiempo total de hospitalización fue de 21 días. Se presentó una pérdida del injerto pancreático y una pérdida del injerto renal. Hubo una sola muerte, causada por aspergilosis pulmonar.
Conclusiones. La derivación exocrina duodenal permite y facilita la evaluación y el seguimiento endoscópico del injerto pancreático. No supone una mayor exigencia técnica en el trasplante simultáneo de riñón y páncreas, ni un incremento en el número de complicaciones en relación directa con la modificación del procedimiento quirúrgico
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Referencias bibliográficas
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10. Mauer M, Fioretto P. Pancreas transplantation and reversal of diabetic nephropathy lesions. Med Clin North Am. 2013;97: 109-14.
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https://doi.org/10.1097/00000658-200211000-00003
13. Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Nanni G, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015 5;386:964-73.
https://doi.org/10.1016/S0140-6736(15)00075-6
14. Pok EH, Lee WJ. Gastrointestinal metabolic surgery for the treatment of type 2 diabetes mellitus. World J Gastroenterol. 2014;20:14315-28.
https://doi.org/10.3748/wjg.v20.i39.14315
15. Khubutia M, Pinchuk A, Dmitriev I, Storozhev R. Simultaneous pancreas-kidney transplantation with duodeno-duodenal anastomosis. Transplant Proc. 2014;46:1905-9.
https://doi.org/10.1016/j.transproceed.2014.05.070
16. Lindahl JP, Jenssen T, Hartmann A. Long-term outcomes after organ transplantation in diabetic end-stage renal disease. Diabetes Res Clin Pract. 2014;105:14-21.17. Gunasekaran G, Wee A, Rabets J, Winans C, Krishnamurthi V. Duodenoduodenostomy in pancreas transplantation. Clin Transplant. 2012;26:550-7.
https://doi.org/10.1111/j.1399-0012.2011.01563.x
18. Kelly WD, Lillehei RC, Merkel FK, Idezuki Y, Goetz FC. Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy. Surgery. 1967;61:827-37.
19. Squifflet JP, Gruessner RW, Sutherland DE. The history of pancreas transplantation: Past, present and future. Acta Chir Belg. 2008;108:367-78.
https://doi.org/10.1080/00015458.2008.11680243
20. Gliedman ML, Gold M, Whittaker J, Rifkin H, Soberman R, Freed S, et al. Clinical segmental pancreatic transplantation with ureter-pancreatic duct anastomosis for exocrine drainage. Surgery. 1973;74:171-80.
21. Sutherland DE, Goetz FC, Najarian JS. Intraperitoneal transplantation of immediately vascularized segmental pancreatic grafts without duct ligation. A clinical trial. Transplantation. 1979;28:485-91.
https://doi.org/10.1097/00007890-197912000-00010
22. Dubernard JM, Traeger J, Neyra P, Touraine JL, Tranchant D, Blanc-Brunat N. A new method of preparation of segmental pancreatic grafts for transplantation: Trials in dogs and in man. Surgery. 1978;84:633-9.
23. Land W, Gebhardt C, Gall FP, Weitz H, Gokel MJ, Stolte M. Pancreatic duct obstruction with prolamine solution. Transplant Proc. 1980;12(Suppl.2):72-5.
24. McMaster P, Calne RY, Gibby OM, Evans DB. Pancreatic transplantation in man. Transplant Proc. 1980;12(Suppl.2):58-61.
25. Sutherland DE, Goetz FC, Rynasiewicz JJ, Baumgartner D,White DC, Elick BA, et al. Segmental pancreas transplantation from living related and cadaver donors: A clinical experience. Surgery. 1981;90:159-69.
26. Tydén G, Tibell A, Sandberg J, Brattström C, Groth CG. Improved results with a simplified technique for pancreaticoduodenal transplantation with enteric exocrine drainage. Clin Transplant. 1996;10:306-9.
27. Groth CG, Collste H, Lundgren G, Wilczek H, Klintmalm G, Ringdén O, et al. Successful outcome of segmental human pancreatic transplantation with enteric exocrine diversion after modifications in technique. Lancet. 1982;2:522-4.
https://doi.org/10.1016/S0140-6736(82)90601-8
28. Cook K, Sollinger HW, Warner T, Kamps D, Belzer FO. Pancreaticocystostomy: An alternative method for exocrine drainage of segmental pancreatic allografts. Transplantation. 1983;35:634-6.
https://doi.org/10.1097/00007890-198306000-00025
29. Sollinger HW, Cook K, Kamps D, Glass NR, Belzer FO. Clinical and experimental experience with pancreaticocystostomy for exocrine pancreatic drainage in pancreas transplantation. Transplant Proc. 1984;16:749-51.
30. Prieto M, Sutherland DE, Goetz FC, Rosenberg ME, Najarian JS. Pancreas transplant results according to the technique of duct management: Bladder versus enteric drainage. Surgery. 1987;102:680-91.
31. Sollinger HW, Odorico JS, Becker YT, D'Alessandro AM, Pirsch JD. One thousand simultaneous pancreas-kidney transplants at a single center with 22-year follow-up. Ann Surg. 2009;250: 618-30.
https://doi.org/10.1097/SLA.0b013e3181b76d2b
32. Gruessner AC, Sutherland DE. 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 June 2004. Clin Transplant. 2005;19:433-55.
https://doi.org/10.1111/j.1399-0012.2005.00378.x
33. De Roover A, Coimbra C, Detry O, van Kemseke C, Squifflet JP, Honore P, et al. Pancreas graft drainage in recipient duodenum: Preliminary experience. Transplantation. 2007;84:795-7.
https://doi.org/10.1097/01.tp.0000281401.88231.da
34. Hummel R, Langer M, Wolters HH, Senninger N, Brockmann JG. Exocrine drainage into the duodenum: A novel technique for pancreas transplantation. Transpl Int. 2008;21:178-81.
35. Serrano OJ, Villegas JI, Echeverri GJ, Posada JG, Mesa L, Schweineberg J, et al. Trasplante simultáneo de riñón y páncreas en pacientes con diabetes mellitus de tipo 1, Clínica Fundación Valle del Lili, Cali, 2001-2013. Rev Colomb Cir. 2014;29:32-41.
36. Boggi U, Vistoli F, Signori S, Del Chiaro M, Campatelli A, Amorese G, et al. A technique for retroperitoneal pancreas transplantation with portal-enteric drainage. Transplantation. 2005;79:1137-42.
https://doi.org/10.1097/01.TP.0000157279.39761.CC
37. Walter M, Jazra M, Kykalos S, Kuehn P, Michalski S, Klein T, et al. 125 cases of duodenoduodenostomy in pancreas transplantation: A single-centre experience of an alternative enteric drainage. Transpl Int. 2014;27:805-15.
https://doi.org/10.1111/tri.12337
38. Shokouh-Amiri H, Zakhary JM, Zibari GB. A novel technique of portal-endocrine and gastric-exocrine drainage in pancreatic transplantation. J Am Coll Surg. 2011;212:730-9.
https://doi.org/10.1016/j.jamcollsurg.2010.12.045
39. Humar A, Ramcharan T, Kandaswamy R, Gruessner RW, Gruessner AC, Sutherland DE. Technical failures after pancreas transplants: Why grafts fail and the risk factors--a multivariate analysis. Transplantation. 2004;78:1188-92.
https://doi.org/10.1097/01.TP.0000137198.09182.A2
40. Grochowiecki T, Galazka Z, Madej K, Frunze S, Nazarewski S, Jakimowicz T, et al. Surgical complications related to transplanted pancreas after simultaneous pancreas and kidney transplantation. Transplant Proc. 2014;46:2818-21.
https://doi.org/10.1016/j.transproceed.2014.08.012
41. Gruessner AC. 2011 update on pancreas transplantation: Comprehensive trend analysis of 25,000 cases followed up over the course of twenty-four years at the International Pancreas Transplant Registry (IPTR). Rev Diabet Stud. 2011;8:6-16.
https://doi.org/10.1900/RDS.2011.8.6
42. Redfield RR, Scalea JR, Odorico JS. Simultaneous pancreas and kidney transplantation: Current trends and future directions. Curr Opin Organ Transplant. 2015;20:94-102.
https://doi.org/10.1097/MOT.0000000000000146
43. Mohan S, Palanisamy A, Tsapepas D, Tanriover B, Crew RJ, Dube G, et al. Donor-specific antibodies adversely affect kidney allograft outcomes. J Am Soc Nephrol. 2012;23:2061-71.
https://doi.org/10.1681/ASN.2012070664
44. Echeverri GJ, Sabogal AN, Caicedo LA, Casas LA, Mesa L, Schweineberg J, et al. Primer trasplante de islotes realizado en Colombia, experiencia fundación Valle del Lili. Revista Colombiana de Endocrinología, Diabetes y Metabolismo. 2015;2:33-9.
45. Sabogal AN, Casas LA, Arango LG, Ferriz K, Guzmán G, Gutiérrez O, et al. Presente y futuro del trasplante de islotes pancreáticos, un tratamiento innovador para la diabetes tipo 1. Revista Colombiana de Endocrinología, Diabetes y Metabolismo. 2015; 2:20-32.
https://doi.org/10.1590/S1679-45082015RW3163
2. Shyr YM. Pancreas transplantation. J Chin Med Assoc. 2009;72:4-9.
https://doi.org/10.1016/S1726-4901(09)70012-7
3. Han DJ, Sutherland DE. Pancreas transplantation. Gut Liver. 2010;4:450-65.
https://doi.org/10.5009/gnl.2010.4.4.450
4. Bunnapradist S, Cho YW, Cecka JM, Wilkinson A, Danovitch GM. Kidney allograft and patient survival in type I diabetic recipients of cadaveric kidney alone versus simultaneous pancreas kidney transplants: A multivariate analysis of the UNOS database. J Am Soc Nephrol. 2003;14:208-13.
https://doi.org/10.1097/01.ASN.0000037678.54984.41
5. Steen DC. The current state of pancreas transplantation. AACN Clin Issues. 1999;10:164-75.
https://doi.org/10.1097/00044067-199905000-00004
6. Kobayashi T, Gruessner AC, Wakai T, Sutherland DE. Three types of simultaneous pancreas and kidney transplantation. Transplant Proc. 2014;46:948-53.
https://doi.org/10.1016/j.transproceed.2013.11.058
7. Kandaswamy R, Stock PG, Skeans MA, Gustafson SK, Sleeman EF, Wainright JL, et al. OPTN/SRTR 2011 Annual Data Report: Pancreas. Am J Transplant. 2013;13(Suppl.1):47-72.
https://doi.org/10.1111/ajt.12020
8. Kandaswamy R, Skeans MA, Gustafson SK, Carrico RJ, Tyler KH, Israni AK, et al. OPTN/SRTR 2013 Annual Data Report: Pancreas. Am J Transplant. 2015;15 (Suppl.2):1-20.
https://doi.org/10.1111/ajt.13196
9. Robertson P, Davis C, Larsen J, Stratta R, Sutherland DE; American Diabetes Association. Pancreas transplantation in type 1 diabetes. Diabetes Care. 2004;27(Suppl.1):S105.
https://doi.org/10.2337/diacare.27.2007.S105
10. Mauer M, Fioretto P. Pancreas transplantation and reversal of diabetic nephropathy lesions. Med Clin North Am. 2013;97: 109-14.
https://doi.org/10.1016/j.mcna.2012.10.009
11. McLaren AJ, Friend PJ. Trends in organ preservation. Transpl Int. 2003;16:701-8.
https://doi.org/10.1111/j.1432-2277.2003.tb00227.x
12. Rubino F, Gagner M. Potential of surgery for curing type 2 diabetes mellitus. Ann Surg. 2002;236:554-9.
https://doi.org/10.1097/00000658-200211000-00003
13. Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Nanni G, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015 5;386:964-73.
https://doi.org/10.1016/S0140-6736(15)00075-6
14. Pok EH, Lee WJ. Gastrointestinal metabolic surgery for the treatment of type 2 diabetes mellitus. World J Gastroenterol. 2014;20:14315-28.
https://doi.org/10.3748/wjg.v20.i39.14315
15. Khubutia M, Pinchuk A, Dmitriev I, Storozhev R. Simultaneous pancreas-kidney transplantation with duodeno-duodenal anastomosis. Transplant Proc. 2014;46:1905-9.
https://doi.org/10.1016/j.transproceed.2014.05.070
16. Lindahl JP, Jenssen T, Hartmann A. Long-term outcomes after organ transplantation in diabetic end-stage renal disease. Diabetes Res Clin Pract. 2014;105:14-21.17. Gunasekaran G, Wee A, Rabets J, Winans C, Krishnamurthi V. Duodenoduodenostomy in pancreas transplantation. Clin Transplant. 2012;26:550-7.
https://doi.org/10.1111/j.1399-0012.2011.01563.x
18. Kelly WD, Lillehei RC, Merkel FK, Idezuki Y, Goetz FC. Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy. Surgery. 1967;61:827-37.
19. Squifflet JP, Gruessner RW, Sutherland DE. The history of pancreas transplantation: Past, present and future. Acta Chir Belg. 2008;108:367-78.
https://doi.org/10.1080/00015458.2008.11680243
20. Gliedman ML, Gold M, Whittaker J, Rifkin H, Soberman R, Freed S, et al. Clinical segmental pancreatic transplantation with ureter-pancreatic duct anastomosis for exocrine drainage. Surgery. 1973;74:171-80.
21. Sutherland DE, Goetz FC, Najarian JS. Intraperitoneal transplantation of immediately vascularized segmental pancreatic grafts without duct ligation. A clinical trial. Transplantation. 1979;28:485-91.
https://doi.org/10.1097/00007890-197912000-00010
22. Dubernard JM, Traeger J, Neyra P, Touraine JL, Tranchant D, Blanc-Brunat N. A new method of preparation of segmental pancreatic grafts for transplantation: Trials in dogs and in man. Surgery. 1978;84:633-9.
23. Land W, Gebhardt C, Gall FP, Weitz H, Gokel MJ, Stolte M. Pancreatic duct obstruction with prolamine solution. Transplant Proc. 1980;12(Suppl.2):72-5.
24. McMaster P, Calne RY, Gibby OM, Evans DB. Pancreatic transplantation in man. Transplant Proc. 1980;12(Suppl.2):58-61.
25. Sutherland DE, Goetz FC, Rynasiewicz JJ, Baumgartner D,White DC, Elick BA, et al. Segmental pancreas transplantation from living related and cadaver donors: A clinical experience. Surgery. 1981;90:159-69.
26. Tydén G, Tibell A, Sandberg J, Brattström C, Groth CG. Improved results with a simplified technique for pancreaticoduodenal transplantation with enteric exocrine drainage. Clin Transplant. 1996;10:306-9.
27. Groth CG, Collste H, Lundgren G, Wilczek H, Klintmalm G, Ringdén O, et al. Successful outcome of segmental human pancreatic transplantation with enteric exocrine diversion after modifications in technique. Lancet. 1982;2:522-4.
https://doi.org/10.1016/S0140-6736(82)90601-8
28. Cook K, Sollinger HW, Warner T, Kamps D, Belzer FO. Pancreaticocystostomy: An alternative method for exocrine drainage of segmental pancreatic allografts. Transplantation. 1983;35:634-6.
https://doi.org/10.1097/00007890-198306000-00025
29. Sollinger HW, Cook K, Kamps D, Glass NR, Belzer FO. Clinical and experimental experience with pancreaticocystostomy for exocrine pancreatic drainage in pancreas transplantation. Transplant Proc. 1984;16:749-51.
30. Prieto M, Sutherland DE, Goetz FC, Rosenberg ME, Najarian JS. Pancreas transplant results according to the technique of duct management: Bladder versus enteric drainage. Surgery. 1987;102:680-91.
31. Sollinger HW, Odorico JS, Becker YT, D'Alessandro AM, Pirsch JD. One thousand simultaneous pancreas-kidney transplants at a single center with 22-year follow-up. Ann Surg. 2009;250: 618-30.
https://doi.org/10.1097/SLA.0b013e3181b76d2b
32. Gruessner AC, Sutherland DE. 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 June 2004. Clin Transplant. 2005;19:433-55.
https://doi.org/10.1111/j.1399-0012.2005.00378.x
33. De Roover A, Coimbra C, Detry O, van Kemseke C, Squifflet JP, Honore P, et al. Pancreas graft drainage in recipient duodenum: Preliminary experience. Transplantation. 2007;84:795-7.
https://doi.org/10.1097/01.tp.0000281401.88231.da
34. Hummel R, Langer M, Wolters HH, Senninger N, Brockmann JG. Exocrine drainage into the duodenum: A novel technique for pancreas transplantation. Transpl Int. 2008;21:178-81.
35. Serrano OJ, Villegas JI, Echeverri GJ, Posada JG, Mesa L, Schweineberg J, et al. Trasplante simultáneo de riñón y páncreas en pacientes con diabetes mellitus de tipo 1, Clínica Fundación Valle del Lili, Cali, 2001-2013. Rev Colomb Cir. 2014;29:32-41.
36. Boggi U, Vistoli F, Signori S, Del Chiaro M, Campatelli A, Amorese G, et al. A technique for retroperitoneal pancreas transplantation with portal-enteric drainage. Transplantation. 2005;79:1137-42.
https://doi.org/10.1097/01.TP.0000157279.39761.CC
37. Walter M, Jazra M, Kykalos S, Kuehn P, Michalski S, Klein T, et al. 125 cases of duodenoduodenostomy in pancreas transplantation: A single-centre experience of an alternative enteric drainage. Transpl Int. 2014;27:805-15.
https://doi.org/10.1111/tri.12337
38. Shokouh-Amiri H, Zakhary JM, Zibari GB. A novel technique of portal-endocrine and gastric-exocrine drainage in pancreatic transplantation. J Am Coll Surg. 2011;212:730-9.
https://doi.org/10.1016/j.jamcollsurg.2010.12.045
39. Humar A, Ramcharan T, Kandaswamy R, Gruessner RW, Gruessner AC, Sutherland DE. Technical failures after pancreas transplants: Why grafts fail and the risk factors--a multivariate analysis. Transplantation. 2004;78:1188-92.
https://doi.org/10.1097/01.TP.0000137198.09182.A2
40. Grochowiecki T, Galazka Z, Madej K, Frunze S, Nazarewski S, Jakimowicz T, et al. Surgical complications related to transplanted pancreas after simultaneous pancreas and kidney transplantation. Transplant Proc. 2014;46:2818-21.
https://doi.org/10.1016/j.transproceed.2014.08.012
41. Gruessner AC. 2011 update on pancreas transplantation: Comprehensive trend analysis of 25,000 cases followed up over the course of twenty-four years at the International Pancreas Transplant Registry (IPTR). Rev Diabet Stud. 2011;8:6-16.
https://doi.org/10.1900/RDS.2011.8.6
42. Redfield RR, Scalea JR, Odorico JS. Simultaneous pancreas and kidney transplantation: Current trends and future directions. Curr Opin Organ Transplant. 2015;20:94-102.
https://doi.org/10.1097/MOT.0000000000000146
43. Mohan S, Palanisamy A, Tsapepas D, Tanriover B, Crew RJ, Dube G, et al. Donor-specific antibodies adversely affect kidney allograft outcomes. J Am Soc Nephrol. 2012;23:2061-71.
https://doi.org/10.1681/ASN.2012070664
44. Echeverri GJ, Sabogal AN, Caicedo LA, Casas LA, Mesa L, Schweineberg J, et al. Primer trasplante de islotes realizado en Colombia, experiencia fundación Valle del Lili. Revista Colombiana de Endocrinología, Diabetes y Metabolismo. 2015;2:33-9.
45. Sabogal AN, Casas LA, Arango LG, Ferriz K, Guzmán G, Gutiérrez O, et al. Presente y futuro del trasplante de islotes pancreáticos, un tratamiento innovador para la diabetes tipo 1. Revista Colombiana de Endocrinología, Diabetes y Metabolismo. 2015; 2:20-32.
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2016-07-01
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Caicedo, L. A. .; Gómez-Vega, . J. C. .; Serrano, . Óscar J. .; Manzi, E. .; Posada, . J. G. .; Mesa Mesa, . L.; Schweineberg, . J. .; Durán, . C. E. D.; Arrunátegui, A. M. .; Dávalos, D. . Derivación Exocrina Al Duodeno En Trasplante simultáneo De riñón Y páncreas, Experiencia En La Fundación Valle De Lili, Cali, Colombia. Rev Colomb Cir 2016, 31, 178-184.
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