Biomedical subjects
Publications and source records attributed to K C Moudry-Munns.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Since our report at the 1984 American Surgical Association meeting of 100 pancreas transplants from 1966 through 1983, another 190 have been performed. The current series, begun in 1978, now numbers 276 cases, and includes 133 nonuremic recipients of pancreas transplants alone (PTA), 46 simultaneous pancreas/kidney transplants (SPK), and 97 pancreas tranplants after a kidney transplant (PAK). Duct management techniques used were free intraperitoneal drainage in 44 cases, duct occlusion in 44, enteric drainage in 89, and bladder drainage in 128. The 1-year patient and graft survival rates in the entire cohort of 276 were 91% and 42%. One-year patient survival rates were 88% in the first 100, 91% in the second 100, and 92% in the last 76 cases; corresponding 1-year graft survival rates were 28%, 47%, and 56% (p less than 0.05). A prospective comparison of bladder drainage (n = 82) versus enteric drainage (n = 46) in PAK/PTA cases since November 1, 1984 favored bladder drainage (1-year graft survival rates of 52% vs. 41%) because of urinary amylase monitoring. The best results were in recipients of primary SPK bladder-drained transplants (n = 39), with a 1-year pancreas graft survival rate of 75%, kidney graft survival rate of 80%, and patient survival rate of 95%. Logistic regression analysis, with 1-year graft function as the independent variable, showed significant (p less than 0.05) predictors of success (odds ratio) to be technique: bladder drainage (5.8) versus enteric drainage (2.5) versus duct injection (1.0); category: SPK (6.0) versus PAK from same donor (3.2) versus PAK from different donor (1.2) versus PTA (1.0); and donor HLA DR mismatch: 0 (5.0) versus 1 (2.5) versus 2 (1.0) antigens. On April 1, 1989, 90 patients had functioning grafts (60 euglycemic and insulin-free for more than 1 year, 10 for 5 to 10 years); these, along with 24 others whose grafts functioned for 1 to 6 years before failing, are part of an expanding cohort in whom the influence of inducing a euglycemic state on pre-existing secondary complications of diabetes is being studied. Only preliminary data is available. In regard to neuropathy, at more than 1 year after transplant in patients with functioning grafts, conduction velocities in some nerves were increased over baseline. In regard to retinopathy, deterioration in grade occurred in approximately 30% of the recipients by 3 years, whether the graft functioned continuously or failed early, but thereafter retinopathy in the patients with functioning grafts remained stable.(ABSTRACT TRUNCATED AT 400 WORDS)
This report contains information on analysis of 2,292 pancreas transplants worldwide reported to the International Pancreas Transplant Registry from 1966 through 1989, with 1-year recipient survival rates improving from 39% to 71% to 80% to 87% and 1-year graft survival rates from 5% to 26% to 40% to 56% for 1966 to 1977 (n = 64), 1977 to 1983 (n = 336), 1984 to 1985 (n = 364), and 1986 to 1989 (n = 1,220) cases, respectively. The last 2 eras were combined for analyses of multiple variables. In the analyses of all world cases for the 1984 to 1989 period (n = 1,604), the most important finding was the influence of HLA-DR matching or mismatching on pancreas graft survival rates; 1-year function rates for grafts in recipients matched for 2, 1, or 0 DR antigens with the donor were 73% (n = 52), 53%, (n = 468), and 48% (n = 67) (p less than 0.005 for all comparisons). Likewise, in an analysis of 1984 to 1989 cases according to DR mismatching, the 1-year graft survival rates with 0, 1, or 2 DR mismatches were 63% (n = 128), 50% (n = 583), and 49% (496) (p less than 0.02). An analysis of the 1986 to 1989 era cases worldwide confirms the trend in the period analysis for bladder drainage (BD) to be associated with significantly higher graft survival rates than intestinal drainage or duct injection, at 1-year being 59% (n = 656), 47% (n = 97), and 54% (n = 210). Likewise, for the 1986 to 1989 era, worldwide 1-year pancreas graft functional survival rates were significantly higher in recipients of simultaneous-pancreas/kidney transplants (SPK) than in recipients of pancreas-after-kidney (PAK) or a pancreas-transplant-alone (PTA); 63% (n = 865), 45% (n = 186), and 37% (n = 165). In a new analysis of the United States cases reported to the UNOS Registry from October 1, 1987 through June 30, 1989, 1-year patient and graft survival rates were 91% and 69%. Almost all United States cases reported to the UNOS Registry during 1987 to 1989 were with BD (n = 324).(ABSTRACT TRUNCATED AT 400 WORDS)
From December 1966 to December 1988, 1,830 pancreas transplants were reported to the International Pancreas Transplant Registry. Of these, 1,549 were reported as of June 30, 1988 and analyzed on July 13, 1988. One-year actuarial graft function (insulin-independent) and recipient survival rates for all cases were 42% and 80%, respectively. In an analysis by era of 1966 to 1977 (n = 64), 1978 to 1983 (n = 336), 1984 to 1985 (n = 387), and 1986 to 1988 (n = 762) cases, 1-year graft function rates were 5%, 25%, 41%, and 55% and recipient survival rates were 44%, 72%, 81%, and 88%, respectively (p less than or equal to 0.01 all comparisons). In an analysis of 1984 to 1988 cases only (n = 1,149), the overall 1-year graft function and patient survival rates were 49% and 85%, respectively. During this period, graft functional survival rates for the most common duct management methods were 53% for duct injection (n = 313), 45% for intestinal drainage (n = 257), and 51% for bladder drainage (n = 535) at 1 year (p less than 0.04 for intestinal vs bladder drainage). Graft function rates were similar for whole (n = 552) and segmental (n = 595) pancreas transplants (48% vs 50% at 1 year). Functional survival rates according to duration of preservation for grafts stored less than 6 hours (n = 706), 6-12 hours (n = 243), 12-24 hours (n = 95), and 12-24 hours (n = 9) were 50%, 47%, 43%, and 78% at 1 year, and none of the differences were significant. Graft functional survival rates for 1984 to 1988 cases were significantly higher (p less than 0.05) in recipients who received AZA and CsA in combination (n = 895) than in those who received CsA without AZA (n = 218) or AZA without CsA, (n = 27), with 1-year graft functional survival rates of 52%, 41%, and 33%, respectively. For technically successful grafts, the function survival rates were also significantly higher (p less than 0.05) in recipients treated with CsA + AZA (n = 708) than in those who received CsA without AZA (n = 156) or AZA without CsA (n = 19), with 1-year function rates of 66%, 56%, and 47%, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)