Modified upper abdominal cluster transplantation in patients with end-stage liver diseases associated with insulin dependent type 2 diabetes mellitus
10.3760/cma.j.issn.0254-1785.2011.05.002
- VernacularTitle:腹部器官簇移植治疗终末期肝病合并胰岛素依赖的2型糖尿病五例
- Author:
Xiaoshun HE
;
Linwei WU
;
Xiaofeng ZHU
;
Dongping WANG
;
Weiqiang JU
;
Yi MA
;
Qiang TAI
;
Anbin HU
;
Zhiyong GUO
;
Yali TAN
;
Ming HAN
;
Guodong WANG
;
Jiefu HUANG
- Publication Type:Journal Article
- Keywords:
Cluster transplantation;
Liver;
Pancreas;
Liver failure;
Diabetes mellitus,type 2
- From:
Chinese Journal of Organ Transplantation
2011;32(5):260-263
- CountryChina
- Language:Chinese
-
Abstract:
Objective Modified upper abdominal cluster transplantation (MCT), which was inspired by the classical cluster transplant technique, has been proven more effective and feasible in the treatment of patients with end stage liver diseases associated with insulin-dependent diabetes mellitus (DM) than orthotopic liver transplantation (OLT) alone. In this study, we summarized our experience with MCT in 5 consecutive patients suffering from end stage liver diseases associated with insulin-dependent type 2 DM in our single center.Methods Five patients with hepatitis B-related chronic liver cirrhosis and insulin dependent type 2 DM received MCT in our single center. The biliary and exocrine pancreatic drainage reconstructions were achieved by a Roux-en-Y duodenojejunostomy or a side-to-side duodenojejunostomy. A quadruple immunosuppressive regimen based on tacrolimus including Basiliximab induction, mycophenolate mofetil (MMF) and steroids was used in the early stage post-transplant, and then converted to tacrolimus monotherapy.Results All of the patients experienced an uneventful post-operative recovery. They were rendered independent from insulin therapy shortly after transplantation. The fasting glucose and glycosylated hemoglobin levels were within normal range. In addition, the fasting C-peptide value was increased from much lower than the normal range pre-transplant to within normal range post-transplant and maintained stable since then. However, the third patient suffered from graft verse host disease (GVHD) 20 days post-operatively and died from severe infection on the post-operative 47 days. The other 4 patients had returned to work and a normal lifestyle over 22, 15, 5 and 4 months of follow-up.Conclusion MCT is an effective method in treating patients suffering from end stage liver diseases combined with insulin-dependent type 2 DM. Whether a cluster graft would increase the risk of GVHD needs further investigation.
