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Advisor(s)
Abstract(s)
A Diabetes Mellitus (DM) Ć© uma doenƧa crĆ³nica com elevada prevalĆŖncia mundial,
caracterizada pela insuficiente produĆ§Ć£o pancreĆ”tica de insulina ou pela incapacidade de o
organismo utilizar esta hormona, levando a um estado hiperglicƩmico persistente. A DM
Tipo 2 (DMT2) Ć© um dos principais tipos de diabetes, acometendo 90-95% dos casos.
A hiperglicemia persistente a que estes pacientes estĆ£o sujeitos resulta em inĆŗmeros
efeitos lesivos, originando complicaƧƵes das quais se destacam a nefropatia, a neuropatia e
a retinopatia diabƩticas.
A nefropatia diabĆ©tica Ć© a principal causa de DoenƧa Renal CrĆ³nica Terminal
(DRCT), correspondendo a uma diminuiĆ§Ć£o progressiva da funĆ§Ć£o renal. Assim, pacientes
selecionados, com DRCT e diabetes concomitante, podem beneficiar de transplante
simultĆ¢neo do pĆ¢ncreas e do rim [SPKT] restabelecendo eficazmente a funĆ§Ć£o endĆ³crina e
renal.
Para alĆ©m deste tipo de transplante, esta revisĆ£o tambĆ©m abordarĆ” os seguintes,
menos comuns: PBKT [Transplante PancreƔtico PrƩvio ao Renal], PTA [Transplante
Isolado do PĆ¢ncreas], SPLKT [Transplante SimultĆ¢neo de PĆ¢ncreas, FĆgado e Rim], PAKT
[Transplante PancreĆ”tico ApĆ³s Transplante Renal], PALT [Transplante PancreĆ”tico ApĆ³s
Transplante HepƔtico] e FPSCT [Transplante de CƩlulas-Tronco PancreƔticas Fetais].
Se, por um lado, Ć© consensual a realizaĆ§Ć£o criteriosa do transplante pancreĆ”tico em
diabĆ©ticos tipo 1, o mesmo nĆ£o se verifica ainda na diabetes tipo 2, onde a sua aplicabilidade
ainda Ć© questionada. Deste modo, esta revisĆ£o tem como objetivo analisar quais os
outcomes principais associados ao transplante pancreƔtico nos diabƩticos tipo 2 e aferir a
sua viabilidade. Para isso, realizamos uma pesquisa bibliogrƔfica na PubMed, Scopus e ISI
Web of Science, da qual resultaram 17 artigos posteriormente incluĆdos nesta revisĆ£o.
Estes artigos descrevem transplantes realizados entre 1995 e 2020, em pacientes
com idades compreendidas entre os 18 e os 65 anos, onde se verificou uma notĆ³ria
discrepĆ¢ncia geogrĆ”fica da intervenĆ§Ć£o em causa, sendo que 53% dos estudos sĆ£o referentes
aos Estados Unidos da AmƩrica.
Nesta revisĆ£o de literatura, inferiu-se ainda que o transplante pancreĆ”tico em
pacientes com Diabetes Mellitus Tipo 2 Ć© uma prĆ”tica em expansĆ£o contĆnua e que o SPKT
Ć© o mais comummente realizado.
Em relaĆ§Ć£o aos outcomes, verificou-se que o nĆvel de HbA1c, a glicose mĆ©dia e a
necessidade diĆ”ria de insulina sofreram uma evoluĆ§Ć£o positiva significativa apĆ³s o
transplante. O nĆvel de pĆ©ptido-C subiu na maioria dos estudos, demonstrando a evoluĆ§Ć£o
positiva da produĆ§Ć£o endĆ³gena de insulina. Quanto Ć s complicaƧƵes associadas ao transplante, as taxas de rejeiĆ§Ć£o variaram
entre os 10% e os 36%, e as restantes complicaƧƵes cirĆŗrgicas (tais como infeƧƵes, abcessos,
hemorragias e leaks pancreƔticos) variaram de 0% a 83%.
A taxa de sobrevivĆŖncia dos pacientes foi superior a 90%, 1 ano apĆ³s o transplante,
mas com posterior decrĆ©scimo para 75%-90% 5 anos apĆ³s o procedimento. Em relaĆ§Ć£o aos
enxertos, estes apresentaram uma taxa de sobrevivĆŖncia inferior, variando de 80% a 90%
apĆ³s 1 ano de transplante e, posteriormente, de 60% a 70% aquando dos 5 anos pĆ³sintervenĆ§Ć£o.
Concluindo, verificou-se uma tendĆŖncia positiva nos outcomes do transplante
pancreĆ”tico em diabĆ©ticos tipo 2, com taxas de sobrevivĆŖncia e indicadores analĆticos de
manutenĆ§Ć£o da doenƧa a demonstrarem o sucesso da abordagem. Assim, demonstrou-se a
necessidade de ponderar o transplante pancreĆ”tico como um novo mĆ©todo terapĆŖutico, e
eventual cura, de uma das mais preponderantes epidemias do sƩculo XXI.
Diabetes Mellitus (DM) is a chronic disease with a high worldwide prevalence, characterized by insufficient pancreatic insulin production or by the body's inability to use the hormone, leading to a persistent hyperglycaemic state. Type 2 DM is responsible for most of the cases, affecting 90-95% of diabetesā patients. The persistent hyperglycaemia to which these patients are subject results in numerous harmful effects, leading to complications such as nephropathy, neuropathy, and diabetic retinopathy. Diabetic nephropathy is the main cause of end-stage Chronic Kidney Disease (CKD) and is characterised as a progressive decrease in kidney function. Thus, selected patients with concurrent end-stage CKD and diabetes may benefit from simultaneous pancreas and kidney transplantation [SPKT] by effectively restoring endocrine and renal function. In addition to this type of pancreatic transplant, others are addressed in this review: PBKT [Pancreas Before Kidney Transplantation], PTA (Pancreas Transplantation Alone), SPLKT [Simultaneous Pancreas, Liver and Kidney Transplantation], PAKT [Pancreas After Kidney Transplantation], PALT [Pancreas After Liver Transplantation] and FPSCT [Fetal Pancreatic Stem Cell Transplantation]. If, on the one hand, the judicious performance of pancreatic transplantation in type 1 diabetics is consensual, the same does not yet apply to type 2 diabetes, where its appliance is still questioned. Thus, this review aims to analyse what are the main outcomes associated with pancreatic transplantation in type 2 diabetics and to assess its viability. For this, we performed a literature search in PubMed, Scopus and ISI Web of Science, resulting in 17 articles later included in this review which described pancreatic transplantations from 1995 to 2020 in diabetic patients aged 18-65 years old. This study confirms that Pancreatic Transplantation in Patients with Type 2 Diabetes Mellitus is a continually expanding practice and that SPKT is the most commonly performed. The geographic discrepancy of this practice is also notorious, with 53% of the studies referring to the United States of America. Regarding outcomes, HbA1c level, average glycaemia and daily insulin requirements had a significant positive evolution post-transplantation when compared with pretransplantation values. As for C-peptide, its levels either increased or remained constant in most studies, serving as a positive proxy for endogenous production of insulin. As for complications associated with the transplant, rejection rates ranged from 10 to 36%, and the remaining surgical complications (such as infections, abscesses, bleeding and pancreatic leaks) ranged from 0 to 83%. The patient survival rate 1 year post transplant was higher than 90%, decreasing to 75-90% after 5 years. Regarding the grafts viability, these had a lower survival rate, ranging 80-90% after 1 year of transplantation and later, from 60 to 70% at 5 years postintervention. In conclusion, a positive trend in pancreatic transplantation in type 2 diabetes patients was verified, with survival rates and disease management analytical markersā showing the interventionās success. Thus, the need to equate pancreatic transplantation as a new viable therapy, and eventual cure, for one of the most preponderant 21st Century epidemics is demonstrated.
Diabetes Mellitus (DM) is a chronic disease with a high worldwide prevalence, characterized by insufficient pancreatic insulin production or by the body's inability to use the hormone, leading to a persistent hyperglycaemic state. Type 2 DM is responsible for most of the cases, affecting 90-95% of diabetesā patients. The persistent hyperglycaemia to which these patients are subject results in numerous harmful effects, leading to complications such as nephropathy, neuropathy, and diabetic retinopathy. Diabetic nephropathy is the main cause of end-stage Chronic Kidney Disease (CKD) and is characterised as a progressive decrease in kidney function. Thus, selected patients with concurrent end-stage CKD and diabetes may benefit from simultaneous pancreas and kidney transplantation [SPKT] by effectively restoring endocrine and renal function. In addition to this type of pancreatic transplant, others are addressed in this review: PBKT [Pancreas Before Kidney Transplantation], PTA (Pancreas Transplantation Alone), SPLKT [Simultaneous Pancreas, Liver and Kidney Transplantation], PAKT [Pancreas After Kidney Transplantation], PALT [Pancreas After Liver Transplantation] and FPSCT [Fetal Pancreatic Stem Cell Transplantation]. If, on the one hand, the judicious performance of pancreatic transplantation in type 1 diabetics is consensual, the same does not yet apply to type 2 diabetes, where its appliance is still questioned. Thus, this review aims to analyse what are the main outcomes associated with pancreatic transplantation in type 2 diabetics and to assess its viability. For this, we performed a literature search in PubMed, Scopus and ISI Web of Science, resulting in 17 articles later included in this review which described pancreatic transplantations from 1995 to 2020 in diabetic patients aged 18-65 years old. This study confirms that Pancreatic Transplantation in Patients with Type 2 Diabetes Mellitus is a continually expanding practice and that SPKT is the most commonly performed. The geographic discrepancy of this practice is also notorious, with 53% of the studies referring to the United States of America. Regarding outcomes, HbA1c level, average glycaemia and daily insulin requirements had a significant positive evolution post-transplantation when compared with pretransplantation values. As for C-peptide, its levels either increased or remained constant in most studies, serving as a positive proxy for endogenous production of insulin. As for complications associated with the transplant, rejection rates ranged from 10 to 36%, and the remaining surgical complications (such as infections, abscesses, bleeding and pancreatic leaks) ranged from 0 to 83%. The patient survival rate 1 year post transplant was higher than 90%, decreasing to 75-90% after 5 years. Regarding the grafts viability, these had a lower survival rate, ranging 80-90% after 1 year of transplantation and later, from 60 to 70% at 5 years postintervention. In conclusion, a positive trend in pancreatic transplantation in type 2 diabetes patients was verified, with survival rates and disease management analytical markersā showing the interventionās success. Thus, the need to equate pancreatic transplantation as a new viable therapy, and eventual cure, for one of the most preponderant 21st Century epidemics is demonstrated.
Description
Keywords
Diabetes Tipo 2 Hba1c Insulina PƩptido-C Transplante PancreƔtico