Portal vein provides about three-fourths of liver's blood supply. Portal vein is formed behind the neck of pancreas, at the level of the second lumbar vertebra and formed from the convergence of superior mesenteric and splenic veins. The purpose of this study is to review the normal distribution and variation, morphometry of portal vein and its branches for their implication in liver surgery and preoperative portal vein embolization. It is also helpful for radiologists while performing radiological procedures. A total of fresh 40 livers with intact splenic and superior mesenteric vein were collected from the mortuary of Forensic Department, JSS Medical College and Mysuru Medical College. The silicone gel was injected into the portal vein and different segments were identified and portal vein variants were noted. The morphometry of portal vein was measured by using digital sliding calipers. The different types of portal vein segmental variants were observed. The present study showed predominant type I in 90% cases, type II 7.5% cases, and type III 2.5% cases. Mean and standard deviation (SD) of length of right portal vein among males and females were 2.096±0.602 cm and 1.706±0.297 cm, respectively. Mean and SD of length of left portal vein among males and females were 3.450±0.661 cm and 3.075±0.632 cm, respectively. The difference in the Mean among the males and females with respect to length of right portal vein and left portal vein was found to be statistically significant (P=0.010). Prior knowledge of variations regarding the formation, termination and tributaries of portal vein are very helpful and important for surgeons to perform liver surgeries like liver transplantation, segmentectomy and for Interventional Radiologists.
Female ; Humans ; Liver Transplantation ; Liver* ; Male ; Mastectomy, Segmental ; Mesenteric Veins ; Methods* ; Neck ; Pancreas ; Portal Vein* ; Silicon ; Silicones ; Spine ; Splenic Vein ; Surgeons

Since the introduction of pancreas transplantation more than 40 years ago, surgical techniques and immunosuppressive regiments have improved and both have contributed to increase the number and success rate of this procedure. However, graft survival corresponds to early diagnosis of organ-related complications. Thus, knowledge of the transplantation procedure and postoperative image anatomy are basic requirements for radiologists. In this article, we demonstrate the imaging spectrum of pancreas transplantation with enteric exocrine drainage.
Adult ; Anastomosis, Surgical/methods ; Diagnostic Imaging/methods ; Drainage/methods ; Female ; Graft Rejection/pathology ; Graft Survival ; Humans ; Iliac Artery/radiography/surgery ; Immunosuppressive Agents ; Kidney Transplantation ; Male ; *Medical Illustration ; Mesenteric Artery, Superior/radiography/surgery ; Middle Aged ; Pancreas/*blood supply/radiography ; Pancreas Transplantation/adverse effects/*methods ; Pancreatitis, Graft/etiology ; Portal Vein/radiography/surgery ; Postoperative Complications/radiography ; Postoperative Hemorrhage/etiology ; Survival Rate

OBJECTIVETo evaluate the influence of simultaneous pancreas-kidney (SPK) transplantation on the quality of life of diabetic recipients with end-stage renal disease.

METHODSWe performed a retrospective analysis of the data of diabetic patients with end-stage renal disease and evaluated the quality of life of the recipients using SF-36 health survey.

RESULTSOne patient died of cerebrovascular accident, and 7 patients recovered smoothly. During the follow-up lasting for a mean of 23.3 months, the blood glucose, C-peptide and creatine levels of the patients remained stable. The score of 8 domains of SF-36 of the diabetic recipient at 2 years after SPK transplantation showed a significant improvement compared with that before the operation, similar to that of Chinese normal population(P > 0.05).

CONCLUSIONSSPK transplantation can achieve a significant improvement of the quality of life of diabetic patients with end-stage renal disease.

Adult ; Diabetic Nephropathies ; surgery ; Female ; Graft Survival ; Humans ; Kidney Failure, Chronic ; surgery ; Kidney Transplantation ; methods ; Male ; Middle Aged ; Pancreas Transplantation ; methods ; Postoperative Period ; Quality of Life ; Retrospective Studies ; Surveys and Questionnaires

BACKGROUNDThe University of Wisconsin colloid based preserving solution (UW solution) is the most efficient preserving solution for multiorgan transplantation. Unfortunately, unavailability of delayed organ preserving solutions hindered further progression of cardinal organ transplantation in China. In this study, we validated an organ preserving Changzheng Organ Preserving Solution (CZ-1 solution) and compared it with UW solution.

METHODSA series of studies were conducted on how and how long CZ-1 solution could preserve the kidneys, livers, hearts, lungs and pancreas of New Zealand rabbits and SD rats. Morphology of transplanted organs was studied by visible microscopy and electron microscopy; biochemical and physiological functions and the survival rate of the organs during prolonged cold storage were studied.

RESULTSThere was no significant difference between CZ-1 and UW solutions in preserving the kidneys, livers, hearts or lungs of rabbits; kidneys, livers, intestinal mucosa or pancreases of SD rats or five deceased donors' testicles. In some aspects, such as preserving rabbits' hearts, rats' intestinal mucosa and pancreases, the effect of CZ-1 solution was superior to UW solution. CZ-1 could safely preserve kidneys for 72 hours, livers for 24 hours, hearts for 18 hours and lungs for 8 hours for SD rats. Twelve kidneys preserved in cold CZ-1 solution for 22 - 31 hours were transplanted successfully and the mean renal function recovery time was (3.83 +/- 1.68) days.

CONCLUSIONSCZ-1 solution is as effective as UW solution for organ preservation. The development of CZ-1 solution not only reduces costs and improves preservation of organs, but also promotes future development of organ transplantation in China.

Adenosine ; pharmacology ; Allopurinol ; pharmacology ; Animals ; China ; Glutathione ; pharmacology ; Heart ; drug effects ; physiology ; Heart Transplantation ; methods ; Insulin ; pharmacology ; Intestine, Small ; drug effects ; physiology ; Kidney ; drug effects ; physiology ; Kidney Transplantation ; methods ; Liver ; drug effects ; physiology ; Liver Transplantation ; methods ; Lung ; drug effects ; physiology ; Lung Transplantation ; methods ; Male ; Organ Preservation ; economics ; methods ; Organ Preservation Solutions ; pharmacology ; Pancreas ; drug effects ; physiology ; Pancreas Transplantation ; methods ; Pharmaceutical Solutions ; pharmacology ; Rabbits ; Raffinose ; pharmacology ; Testis ; drug effects ; physiology

OBJECTIVETo report the modified technique and the short-term results of simultaneous pancreas-kidney transplantation (SPK) with the enteric drainage (ED) of exocrine secretions.

METHODSFrom June 2000 to August 2006, thirty-eight patients with diabetes complicated with uremia underwent SPK. The pancreas graft was placed intraperitoneally with exocrine secretions drained into the proximal jejunum without Roux-en-Y procedure. The mean cold ischemic times of pancreas and kidney were (10 +/- 2.0) h and (7 +/- 2.0) h, respectively. Quadruple immunosuppressive therapy with antilymphocyte globulin or anti-CD25 monoclonal antibody, tacrolimus, mycophenolate mofetil and steroids was adopted except one patient.

RESULTSThe 6-month survival rates of patients and grafts were both 97.4% after transplantation. All patients achieved insulin-free euglycemia at (7 +/- 6.9) d postoperative except one. For preoperative patients, mean fasting insulin and C-peptide values were (9 +/- 8.1) mU/L and (6 +/- 4.5) mU/L. After operation, fasting insulin and C-peptide values of patients were (12 +/- 5.8) mU/L and (6 +/- 4.7) mU/L, respectively, which peaked to an insulin level of (57 +/- 43.0) mU/L and a C-peptide level of (11 +/- 6.8) mU/L with stimulation. There were eight cases of delayed renal graft function. All other patients achieved immediate renal graft function. No graft losses occurred due to leakage or intra-abdominal infection. The most common surgical complications were wound infection (n = 12), enteric anastomostic hemorrhage (n = 5) and perirenal hemorrhage (n = 2). Three patients (7.9%) had been reoperated for the reasons of intra-abdominal hemorrhage and perirenal hemorrhage.

CONCLUSIONSSPK is an effective treatment option for selected patients with diabetes mellitus and approaching end-stage renal disease. Enteric exocrine drainage by direct side-to-side anastomosis (without Roux-en-Y) seems to be a simple and reliable technique.

Diabetes Mellitus ; surgery ; Drainage ; methods ; Female ; Follow-Up Studies ; Graft Rejection ; prevention & control ; Graft Survival ; Humans ; Immunosuppressive Agents ; therapeutic use ; Jejunum ; surgery ; Kidney Transplantation ; methods ; Male ; Middle Aged ; Pancreas Transplantation ; methods ; Postoperative Complications ; prevention & control ; Treatment Outcome ; Uremia ; surgery

Diabetes Mellitus ; surgery ; Humans ; Kidney Transplantation ; adverse effects ; methods ; trends ; Organ Preservation ; methods ; trends ; Pancreas Transplantation ; adverse effects ; methods ; trends ; Renal Insufficiency ; surgery

OBJECTIVETo identify the effect of PNA CXCR3 on acute rejection of islet allograft.

METHODSThe mice islet transplant models were used. The mice were divided into three groups including saline group, PNA CXCR3 group and mismatch PNA group. In vitro the proliferation capability of T cell was assessed by proliferative responses. RT-PCR and western blot were used to detect the expression of mRNA and protein. Flow cytometry was applied to determine the expression level of CXCR3 in spleen CD3(+) T cells.

RESULTSCompared with saline [(6.72 +/- 1.48) d] and PNA mismatch-treated recipients [(6.54 +/- 0.86) d], PNA CXCR3-treated recipients demonstrated statistically significant prolongation [(9.70 +/- 1.57) d] in functional allograft survival. The CXCR3 mRNA expression level of PNA CXCR3 group (1.06 +/- 0.07) was significantly down-regulated compared with saline (1.98 +/- 0.22) and PNA mismatch (1.87 +/- 0.10) group at the 7th day after transplant. The date showed that CXCR3 protein and lymphocytes proliferation capability was significantly down-regulated in PNA CXCR3 group compared with saline and PNA mismatch group (P<0.01).

CONCLUSIONSThe present study indicates that PNA CXCR3 can inhibit T cell activating and prolonging the survival time of islet allograft and has a substantial therapeutic effect on inhibiting acute allograft rejection.

Animals ; Blotting, Western ; Diabetes Mellitus, Experimental ; surgery ; Graft Rejection ; genetics ; physiopathology ; Graft Survival ; drug effects ; genetics ; physiology ; Mice ; Mice, Inbred BALB C ; Mice, Inbred C57BL ; Oligonucleotides, Antisense ; administration & dosage ; genetics ; Pancreas Transplantation ; methods ; Peptide Nucleic Acids ; administration & dosage ; genetics ; Random Allocation ; Receptors, CXCR3 ; genetics ; metabolism ; physiology ; Reverse Transcriptase Polymerase Chain Reaction ; Signal Transduction ; drug effects ; genetics ; physiology ; Transplantation, Homologous

OBJECTIVETo establish an porcine model of whole pancreaticoduodenal transplantation with portal venous drainage and enteric drainage for ensuring physiologically normal function without hyperinsulinemia and reducing postoperative complications.

METHODSTwenty sichuan native outbreding white pigs weighing 25-30 kg were divided equally into two groups to serve as the donors and recipients. Cooling of the grafts was accomplished with in situ flush with 4 degrees C UW preservation solution via an aortic cannula. A whole pancreatoduodenal graft with the segment of abdominal aorta and the portal vein was harvested from the donor pigs. Type I diabetes model was established by complete removal of the recipient pancreas. The whole pancreatoduodenal graft was preserved and shaped in UW solution, and the subphrenic abdominal aorta of the recipient was joined with the donor abdominal aorta via a side-to-end anastomosis, and venous reflux was reconstructed between the donor portal vein and the recipient superior mesenteric vein. Side-to-side intestinal anastomosis was performed between the donor duodenum and the recipient jejunum.

RESULTSTen pancreaticoduodenal transplantations (PVE+ED style) were done, and pancreatic graft thrombosis and embolism occurred only in 1 pig 6 days after transplantation.

CONCLUSIONThe model of whole pancreaticoduodenal transplantation with portal venous drainage and enteric drainage is stable and reliable.

Animals ; Drainage ; methods ; Duodenum ; transplantation ; Female ; Intestines ; surgery ; Male ; Models, Animal ; Pancreas Transplantation ; Portal Vein ; surgery ; Swine ; Transplantation, Homologous

OBJECTIVETo summarize the treatment experience of long-term surviving patients after combined abdominal organ transplantation.

METHODSFrom October 2001 to January 2005, 19 patients received combined abdominal organ transplantation in Nanfang Hospital, including 6 with simultaneous kidney-pancreas transplantation (SKPT), 12 with combined liver-kidney transplantation (CLKT), and 1 with simultaneous liver-pancreas transplantation (SLPT). The periods of follow up were from 6 months to 3 years and 8 months. Summarize primary diseases of the patients, factors which impacted on patients long-term survival rate, and immunological characteristics of combined abdominal organ transplantation.

RESULTSAll of 19 transplant cases were performed successfully. Among then, 18 were followed up; 16 survived till now; 2 patients undergoing liver-kidney transplantation were dead, one of which died from myocardial infarction in the 18 months after operation, and one died from cytomegalovirus in infection of lung in 13 months; 1 liver-kidney transplantation patient and 2 pancreas-liver transplantation patients experienced acute rejection once; 2 patients were found nephrotoxicity. Among the 18 patients, 4 patients' survival time were over 3 years, 7 over 2 years, 6 over 1 year, 1 over 10 months.

CONCLUSIONSCombined abdominal organ transplantation is effective for treatment of two abdominal organ failure diseases. Factors which impact on patients long-term surviving include choosing suitable recipient, high quality of donated organ, avoidance of surgical complication, the history of myocardial infarction before operation, immunosuppressive regime and virus infection late after transplantation. Combined abdominal organ transplantation has some different immunological characteristics from single organ transplantation.

Adult ; Aged ; Duodenum ; transplantation ; Female ; Follow-Up Studies ; Humans ; Kidney Transplantation ; immunology ; methods ; mortality ; Liver Transplantation ; immunology ; methods ; mortality ; Male ; Middle Aged ; Pancreas Transplantation ; immunology ; methods ; mortality ; Treatment Outcome

No abstract available.
Humans ; Immunosuppression ; *Kidney Transplantation/methods ; *Pancreas Transplantation/methods ; Patient Selection ; Treatment Outcome