In pancreas transplantation, complications can arise at each step of the process,from the initial selection of donors and recipients through the surgical techniqueitself and the post-operative period, when lifelong im...In pancreas transplantation, complications can arise at each step of the process,from the initial selection of donors and recipients through the surgical techniqueitself and the post-operative period, when lifelong immunosuppression isrequired. In the early steps, careful retrieval and preservation of the pancreas arecrucial for the viability of the organ and ultimate success of the transplant. Thepancreas is a low-flow gland, making it highly sensitive to transplantationconditions and presenting risk of pancreatitis due to periods of ischemia. The twogroups of donors - after brain death (DBD) or after cardiac arrest (DCD) - requiredifferent strategies of retrieval and preservation to avoid or reduce the risk ofcomplications developing during and after the transplantation. For DBD donortransplantation, multiorgan retrieval and cold preservation is the conventionaltechnique. Asystole donor (DCD) transplantation, in contrast, can benefit from thenewest technologies, such as hypothermic and especially normothermicpreservation machines (referred to as NECMO), to optimize organ preservation.The latter has led to an increase in the pool of donors by facilitating recuperationof organs for transplantation that would have been discarded otherwise.展开更多
The two-layer cold storage method (TLM) was f irst reported in 1988, consisting of a perfluorochemical (PFC) and initially Euro-Collins' solution, which was later replaced by University of Wisconsin solution (UW)....The two-layer cold storage method (TLM) was f irst reported in 1988, consisting of a perfluorochemical (PFC) and initially Euro-Collins' solution, which was later replaced by University of Wisconsin solution (UW). PFC is a biologically inert liquid and acts as an oxygen-supplying agent. A pancreas preserved using the TLM is oxygenated through the PFC and substrates are supplied by the UW solution. This allows the pancreas preserved using the TLM to generate adenosine triphosphate during storage, prolonging the preservation time. In a canine model, the TLM was shown to repair and resuscitate warm ischemically damaged pancreata during preservation, improve pancreas graft survival after transplantation, and also improve the islet yield after isolation. Clinical trials using the TLM in pancreas preservation before whole-pancreas transplantation and islet isolation have shown promising outcomes. We describe the role of the TLM in pancreas and islet transplantation.展开更多
Pancreatic neuroendocrine neoplasms are a rare and complex group of neoplastic lesions that develop from pancreatic islet cells.Their incidence has dramatically increased during the last two decades.Due to its complex...Pancreatic neuroendocrine neoplasms are a rare and complex group of neoplastic lesions that develop from pancreatic islet cells.Their incidence has dramatically increased during the last two decades.Due to its complex nature and pathophysiological behaviour,surgical management continues to evolve.Surgery remains the cornerstone of treatment for most non-functional and functional pancreatic neuroendocrine tumours,while lymphadenectomy remains a controversial subject.Different techniques,such as pancreas-preserving and minimally invasive approaches,continue to evolve and offer the same overall outcomes as open surgery.This comprehensive review describes in detail the current and most up-todate classification and staging of pancreatic neuroendocrine tumours,explores the rationale for nonsurgical and surgical management,and focuses on surgical treatment and more specifically,on minimally invasive approaches.展开更多
文摘In pancreas transplantation, complications can arise at each step of the process,from the initial selection of donors and recipients through the surgical techniqueitself and the post-operative period, when lifelong immunosuppression isrequired. In the early steps, careful retrieval and preservation of the pancreas arecrucial for the viability of the organ and ultimate success of the transplant. Thepancreas is a low-flow gland, making it highly sensitive to transplantationconditions and presenting risk of pancreatitis due to periods of ischemia. The twogroups of donors - after brain death (DBD) or after cardiac arrest (DCD) - requiredifferent strategies of retrieval and preservation to avoid or reduce the risk ofcomplications developing during and after the transplantation. For DBD donortransplantation, multiorgan retrieval and cold preservation is the conventionaltechnique. Asystole donor (DCD) transplantation, in contrast, can benefit from thenewest technologies, such as hypothermic and especially normothermicpreservation machines (referred to as NECMO), to optimize organ preservation.The latter has led to an increase in the pool of donors by facilitating recuperationof organs for transplantation that would have been discarded otherwise.
文摘The two-layer cold storage method (TLM) was f irst reported in 1988, consisting of a perfluorochemical (PFC) and initially Euro-Collins' solution, which was later replaced by University of Wisconsin solution (UW). PFC is a biologically inert liquid and acts as an oxygen-supplying agent. A pancreas preserved using the TLM is oxygenated through the PFC and substrates are supplied by the UW solution. This allows the pancreas preserved using the TLM to generate adenosine triphosphate during storage, prolonging the preservation time. In a canine model, the TLM was shown to repair and resuscitate warm ischemically damaged pancreata during preservation, improve pancreas graft survival after transplantation, and also improve the islet yield after isolation. Clinical trials using the TLM in pancreas preservation before whole-pancreas transplantation and islet isolation have shown promising outcomes. We describe the role of the TLM in pancreas and islet transplantation.
文摘Pancreatic neuroendocrine neoplasms are a rare and complex group of neoplastic lesions that develop from pancreatic islet cells.Their incidence has dramatically increased during the last two decades.Due to its complex nature and pathophysiological behaviour,surgical management continues to evolve.Surgery remains the cornerstone of treatment for most non-functional and functional pancreatic neuroendocrine tumours,while lymphadenectomy remains a controversial subject.Different techniques,such as pancreas-preserving and minimally invasive approaches,continue to evolve and offer the same overall outcomes as open surgery.This comprehensive review describes in detail the current and most up-todate classification and staging of pancreatic neuroendocrine tumours,explores the rationale for nonsurgical and surgical management,and focuses on surgical treatment and more specifically,on minimally invasive approaches.
