A 14-Year Follow-Up of a Combined Liver-Pancreas-Kidney Transplantation: Case Report and Literature Review
Objective: To investigate the long-term effect of triple organ transplantation (liver, kidney, and pancreas) in a patient with end-stage liver disease, post chronic hepatitis B, cirrhosis, chronic renal failure, and insulin-dependent diabetes mellitus caused by chronic pancreatitis and to explore th...
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Frontiers Media S.A.
2020-04-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fmed.2020.00148/full |
| _version_ | 1818033302215327744 |
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| author | Geng Zhang Weijun Qin Jianlin Yuan Changsheng Ming Shuqiang Yue Zhengcai Liu Lei Yu Ming Yu Xiaokang Gao Yu Zhou Longxin Wang Xiaojian Yang Kefeng Dou He Wang |
| author_facet | Geng Zhang Weijun Qin Jianlin Yuan Changsheng Ming Shuqiang Yue Zhengcai Liu Lei Yu Ming Yu Xiaokang Gao Yu Zhou Longxin Wang Xiaojian Yang Kefeng Dou He Wang |
| author_sort | Geng Zhang |
| collection | DOAJ |
| description | Objective: To investigate the long-term effect of triple organ transplantation (liver, kidney, and pancreas) in a patient with end-stage liver disease, post chronic hepatitis B, cirrhosis, chronic renal failure, and insulin-dependent diabetes mellitus caused by chronic pancreatitis and to explore the optimal surgical procedure.Case: A 43-year-old man with progressive emaciation and hypourocrinia for 2 months. Results indicated exocrine pancreatic insufficiency and insulin-dependent diabetes related to chronic pancreatitis (CP) after developing end-stage hepatic and renal failure. Simultaneous piggyback orthotopic liver and heterotopic pancreas-duodenum and renal transplantation was performed in 2005. Pancreatic exocrine secretions were drained enterically to the jejunum, and the donor kidney was placed in the left iliac fossa. Patient was prescribed with prednisone, tacrolimus, mycophenolate mofetil, Rabbit Anti-human Thymocyte Immunoglobulin, and simulect for immunosuppression.Results: Satisfactory hepatic and pancreatic functional recovery was achieved within 7 days post-surgery. The kidney was not functional, and continuous renal replacement therapy was used. However, the donor kidney was removed at day 16 post-surgery due to acute rejection reaction. A new renal transplantation at the same position was performed, and satisfactory kidney function from the new graft was achieved 3 days later. In 14 years of follow-up, patient has not had any rejection reactions or other complications such as pancreatitis, thrombosis, and localized infections. The patient is insulin independent with normal liver and renal functions. FK506+Pred was used for immunosuppression, and the tac tough level maintained 3.0–4.5 ng/ml. Lamivudine was prescribed for long-term use to inhibit HBV virus duplication.Conclusion: Simultaneous piggyback orthotopic liver and heterotopic pancreas-duodenum and renal transplantation is a good therapeutic option for patients with exocrine pancreatic insufficiency and insulin-dependent diabetes combined with hepatic and renal failure. |
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| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-10T06:21:06Z |
| publishDate | 2020-04-01 |
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| spelling | doaj.art-90ac9b5fa0b6422b8fd2df18564b14f02022-12-22T01:59:20ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2020-04-01710.3389/fmed.2020.00148509827A 14-Year Follow-Up of a Combined Liver-Pancreas-Kidney Transplantation: Case Report and Literature ReviewGeng Zhang0Weijun Qin1Jianlin Yuan2Changsheng Ming3Shuqiang Yue4Zhengcai Liu5Lei Yu6Ming Yu7Xiaokang Gao8Yu Zhou9Longxin Wang10Xiaojian Yang11Kefeng Dou12He Wang13Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, ChinaDepartment of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, ChinaDepartment of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, ChinaInstitute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaDepartment of Hepatobiliary, Xijing Hospital, Fourth Military Medical University, Xi'an, ChinaDepartment of Hepatobiliary, Xijing Hospital, Fourth Military Medical University, Xi'an, ChinaDepartment of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, ChinaDepartment of Ultrasound Diagnostics, Xijing Hospital, Fourth Military Medical University, Xi'an, ChinaDepartment of Urology, General Hospital of Xinjiang Military Region, Urumqi, ChinaDepartment of Urology, Central Theater Command General Hospital of The Chinese People's Liberation Army, Wuhan, ChinaUrology Department, Maanshan People's Hospital, Maanshan, ChinaDepartment of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, ChinaDepartment of Hepatobiliary, Xijing Hospital, Fourth Military Medical University, Xi'an, ChinaDepartment of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, ChinaObjective: To investigate the long-term effect of triple organ transplantation (liver, kidney, and pancreas) in a patient with end-stage liver disease, post chronic hepatitis B, cirrhosis, chronic renal failure, and insulin-dependent diabetes mellitus caused by chronic pancreatitis and to explore the optimal surgical procedure.Case: A 43-year-old man with progressive emaciation and hypourocrinia for 2 months. Results indicated exocrine pancreatic insufficiency and insulin-dependent diabetes related to chronic pancreatitis (CP) after developing end-stage hepatic and renal failure. Simultaneous piggyback orthotopic liver and heterotopic pancreas-duodenum and renal transplantation was performed in 2005. Pancreatic exocrine secretions were drained enterically to the jejunum, and the donor kidney was placed in the left iliac fossa. Patient was prescribed with prednisone, tacrolimus, mycophenolate mofetil, Rabbit Anti-human Thymocyte Immunoglobulin, and simulect for immunosuppression.Results: Satisfactory hepatic and pancreatic functional recovery was achieved within 7 days post-surgery. The kidney was not functional, and continuous renal replacement therapy was used. However, the donor kidney was removed at day 16 post-surgery due to acute rejection reaction. A new renal transplantation at the same position was performed, and satisfactory kidney function from the new graft was achieved 3 days later. In 14 years of follow-up, patient has not had any rejection reactions or other complications such as pancreatitis, thrombosis, and localized infections. The patient is insulin independent with normal liver and renal functions. FK506+Pred was used for immunosuppression, and the tac tough level maintained 3.0–4.5 ng/ml. Lamivudine was prescribed for long-term use to inhibit HBV virus duplication.Conclusion: Simultaneous piggyback orthotopic liver and heterotopic pancreas-duodenum and renal transplantation is a good therapeutic option for patients with exocrine pancreatic insufficiency and insulin-dependent diabetes combined with hepatic and renal failure.https://www.frontiersin.org/article/10.3389/fmed.2020.00148/fullliverpancreasrenalsimultaneous transplantationdiabetes mellitus |
| spellingShingle | Geng Zhang Weijun Qin Jianlin Yuan Changsheng Ming Shuqiang Yue Zhengcai Liu Lei Yu Ming Yu Xiaokang Gao Yu Zhou Longxin Wang Xiaojian Yang Kefeng Dou He Wang A 14-Year Follow-Up of a Combined Liver-Pancreas-Kidney Transplantation: Case Report and Literature Review Frontiers in Medicine liver pancreas renal simultaneous transplantation diabetes mellitus |
| title | A 14-Year Follow-Up of a Combined Liver-Pancreas-Kidney Transplantation: Case Report and Literature Review |
| title_full | A 14-Year Follow-Up of a Combined Liver-Pancreas-Kidney Transplantation: Case Report and Literature Review |
| title_fullStr | A 14-Year Follow-Up of a Combined Liver-Pancreas-Kidney Transplantation: Case Report and Literature Review |
| title_full_unstemmed | A 14-Year Follow-Up of a Combined Liver-Pancreas-Kidney Transplantation: Case Report and Literature Review |
| title_short | A 14-Year Follow-Up of a Combined Liver-Pancreas-Kidney Transplantation: Case Report and Literature Review |
| title_sort | 14 year follow up of a combined liver pancreas kidney transplantation case report and literature review |
| topic | liver pancreas renal simultaneous transplantation diabetes mellitus |
| url | https://www.frontiersin.org/article/10.3389/fmed.2020.00148/full |
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