Objective: Investigate the clinical efficacy of combined en-bloc liver-pancreas transplantation in patients with end stage liver disease and diabetes.

Method: The clinical data of 19 cases of combined en-bloc liver-pancreas transplantation were retrospectively analyzed. The primary diseases of 19 cases were 9 cases of liver cirrhosis after hepatitis B, 7 cases with hepatocellular carcinoma, cholangiocellular carcinoma, and alcoholic cirrhosis of the liver and biliary complications after liver transplantation in 1 case each. All patients were rendered dependent from insulin therapy (62.3±26.8 U/d) before transplantation, duration of diabetes was (4±3.6) years. Mean level of glycosylated hemoglobin and C-peptide in all recipients is 7.9±1.7% and 0.68±0.40nmol/L before transplantation. The pancreas and the whole digestive tract of the recipients were reserved. The liver and pancreas duodenal organ cluster grafts were implanted after the resection of the lesion liver. The liver and kidney function, blood glucose, C-peptide, infection, rejection, vascular complications, biliary complications and other indicators were monitored postoperative.

Result: Median posttransplant follow-up is currently 25.8±25.4 months(1.0 to 96 months). From two weeks after operations, no insulin was used in 18 patients, the blood glucose levels returned to almost normal. Mean glycosylated hemoglobin values decreased from pretransplant 7.9±1.7% to 5.0±0.3% 3 months posttransplantation(P<0.05). Mean C-peptide values increased from pretransplant 0.68±0.40nmol/L to 1.2±0.78 nmol/L 3 months posttransplantation (P<0.05). There was only one recipient (5.3%) who remained exogenous insulin (24 U/d) dependence 1.5 month after transplantation. Alanine aminotransferase(ALT), aspartate aminotransferase(AST) and total bilirubin became normal after 1 week. So far of the followed up, there was no bilary complication. Among the 19 patients, only three recipients died. One died of graft-versus-host disease in 1 month after operation, one died of acute monocytic leukemia in 12.5 months after operation, one died of digestive tract perforation and peritonitis in 26 months after operation.

Conclusion: Our results indicate that combined en-bloc liver-pancreas transplantation is technically feasible and leads to excellent long-term control of glucose metabolism in patients with end-stage liver disease diabetes.

CITATION INFORMATION: Ju W, Lin J, Zhou J, Chen M, Yang A, Wang D, Ma Y, Guo Z, Han M, Wang X, Zhu X, He X. Surgical Techniques in Modified Multiorgan Transplantation. Am J Transplant. 2016;16 (suppl 3).

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