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The search engine that scans this website sends me reports of search terms used n the previous week. Sometimes I can suggest other sources of info, so if your search of my site does not find any matching terms, check back on this page every week or two and see if I have located any better terms to try.

Updated: 2/02/08 Most recent search items at the top of the list.






• 'drawbacks of pancreas transplant': try searching for 'side-effects' or 'adverse' or 'outcome'



• 'pancreas transplant eligibility': There are a number of factors that enter into this decision. The most common criterion that would qualify a patient would be renal failure due to Type I diabetes. A second criterion, and one of the only ones that fits ‘pancreas transplant alone’ procedures, would be very labile Type I diabetes that cannot be successfully managed by conventional methods.
  
  In the first case, several studies have shown that a simultaneous pancreas-kidney transplant can extend the functional life of the kidney graft: the graft pancreas, if successful, dramatically reduces the blood glucose shifts and the subsequent vascular changes that caused the original kidneys to fail.
  
  If kidney transplant is preferred, then adding a pancreas graft does not significantly increase immunosuppression. However the decision to transplant a pancreas for a patient who has adequate renal function is a bit more complex since the immunosuppressive drugs have significant side effects, among these are the nephrotoxic effects of the calcineurin inhibitors.
  
  Type II diabetes is not an indication for pancreas transplantation.
  
  
• 'How much does a kidney weigh?': While there is a reasonable range of sizes for healthy kidneys, each human kidney is about 11 cm long, 5–7 cm wide, and 2.5 cm thick, and weighs from 120–160 grams. The right kidney tends to be placed a bit higher in the abdomen, because the liver takes up a lot of space. They are located mostly outside the peritoneum, but still are cushioned by tissue and fat.
  
  
• 'HIV-positive transplants': Until the late 1990's HIV positive status was considered an absolute contraindication to transplant. However, with the advent of Protease-inhibitor drugs, HIV infection has become a "chronic, but treatable" illness, and in most cases, transplantation is a viable option for organ failure. read more here Many of the same opportuistic infections (CMV, EBV, Kaposi's sarcoma, pneunocystis carini pneumonia) common to HIV patients are also seen in transplant immunosuppression, so a level of vigilance toward these infections is a part of transplant monitoring.
  
  
• 'myeloma kidney': Multiple myeloma can cause a form of nephropathy. This effect generally results from unusual proteins in the bloodstream, light-chain immunologic proteins or Bence-Jones protein. These can deposit in the golmeruli, or damage the glomeruli when the kidney tries to excrete them.
  
  
• 'too many red blood cells' 'high hemoglobin': Unusual increases is hematocrit are rare but post transplant polycythemia or erythrocytosis is reported in about 10% of renal transplant recipients. (This is actually an increase in the number of red blood cells, the hematocrit; in this case, measured hemoglobin is a factor of the increase in hematocrit, it is secondary to polycythemia, it does not cause it.)
  
  Causes are varied and difficult to isolate. The kidney is responsible for the generation of new erythrocytes in bone marrow vis the renal secretion of erythropoietin.
  
  Increased risk of thrombotic events is the principal danger. Treatment with ACE inhibitors usually shows some improvement. In refractory cases, phlebotomy is sometimes required.
  
  
• 'kidney perfusion': The term 'perfusion' basically means 'blood flow', how well 'perfused' the renal tissue is with blood. The kidneys are perhaps the most 'blood-hungry' organs in the human body: at any given moment, about 25% of the total blood supply is in the kidneys. So, any reduction in the blood supply can easily cause a degree of renal failure. Acute renal failure is often a result of a reduced blood supply: blood loss from an injury, a sudden drop in blood pressure, extreme dehydration and subsequent hypovolemia can cause it. In chronic renal disease, changes to the arteries and the arteioles can disrupt adequate blood supply.
  
  A nuclear medicine renal scan or a doppler ultrasound can image the degree of perfusion, and any ischemic regions of renal tissue.
  
  In transplantation, the goal is to 're-perfuse' the donor kidney as soon and as completely as possible.
  
  
• ‘AMR (antibody mediated rejection)’: there are two basic mechanisms in rejection, antibody mediated rejection and cellular mediated rejection. Generally, hyperacute rejection is antibody mediated. Acute rejection is often antibody- and cellular-mediated rejection. Chronic rejection is usually cellular mediated rejection. There is some crossover between these three categories and the definition is impossible to determine with any certainty in the absence of tissue biopsy.
  
  
• 'donor surgical procedures laparoscopic': Laparoscopic and 'hand-assisted' laparoscopic nephrectomy is growing rapidly as a technique to remove a living donor kidney. There is generally less trauma and a faster recovery from this surgery when compared to the open surgery. Laparoscopy is not always the preferred technique however: the length and position of the renal arteries can vary with the individual donor, and this can impact the choice of surgical technique.
  
  
• 'bk virus': The bk and jc polyoma viruses are serious, but usually treatable, opportunistic infections. Treatments vary from simply minimzing immunosuppression to intravenous immunoglobulin therapy. There is some up to date material available at Medscape.com.
  
  
• 'kidney transplant supplements': supplements are a very tricky thing when you are talking about reduced kidney function or talking about a transplanted kidney. i have not investigated all of the 'kidney cure' or 'kidney cleansing' or other supplements on the market, but most of them seem to be based on some form of herbal diuretic of questoinable source, quetionable effectiveness, and untested concentration and safety. Diuresis is not the main problem with reduced kidney function, and trying to boost urine output can even speed up the damage to renal tubules and glomeruli.
  
  When taking immunosuppressive drugs, the blood level of the drug is critical to the effectiveness and the potential toxicity of the drug; hundreds of other drugs/supplements/foods can alter the CYP450 enzyme pathway that is vital to the proper metabolism of these immuno drugs.
  
  So always check everything that you take with your transplant team, whether it is prescrption or non-prescription. it's just too risky not to control the drug levels properly.
  
  A very few may be safe, but unless you are 100% sure about side effects and interactions, it's not an acceptable risk.
  
  
• 'what would happen if you did not have a pancreas': Some people manage to live without any pancreas at all, due to trauma to the organ, cancer, etc. However, the pancreas has two major functions in the body and they are very difficult to replace artificially.
  
  First, the pancreas is critical to management of blood glucose: insulin (from the beta-cells) and glucagon (from the alpha-cells) are the major chemicals that allow other body cells to process glucose in order to release energy, and to store excess blood glucose in a form that the body can use later. A lot of this happens in the liver or in the body cells themselves, but the whole process can't go on without insulin and glucagon.
  
  The other crucial process that is carried out with chemicals from the pancreas (secreted by the bulk of the pancreas, the 'acinar tissue') is basic digestion and metabolism. While the acid enviroment and the muscular activity of the stomach begins to break down food, it is really the addition of acid-neutralizing bicarbonate and pancreatic enzymes lipase, protease, and amylase to the partially digested food in the duodenum that gets the nutrients into a form where they can be absorbed by the intestine to feed the body.
  
  So in theory, it is possible to suport these processes with these chemicals supplied from outside the body, it can never be done with the accuracy that the healthy pancreas provides.
  
  
  
  
• ‘humoral rejection’: there are two basic branches of the immune system, humoral and cellular, but they are present at the same time and can interact. So it is not simple to define their actions separately. The quick answer is that cellular immunity functions more in the T-cells, specifically the cytotoxic T-cells, in concert with the MHC, Major Histocompatibility Complex. Humoral immunity centers on the activation of B-cells, antibodies, and the immunoglobulins (IgA, IgE, IgG, IgM, IgD).
  
  Current thought seems to be that humoral rejection is often harder to resolve than is cell-mediated rejection; the conventional treatments for cellular rejection—steroids, OKT3, ATGAM, MMF, etc—are not always as effective against humoral rejection episodes.
  
  For a detailed discussion of immunity and the immune response, see General Immunology, Dr. C, Douglas Fix.
  
  
• 'dehydration': Dehydration is principally a problem with bladder-drained pancreas grafts, not enteric-drained grafts. The exocrine pancreas secretions (mostly water, bicarbonate ions, and enzymes) can contain a liter or more of fluid per day. In a native pancreas (or an enteric graft) this material empties into the duodenum and the water can be reabsorbed into the bloodstream via the intestine. Bladder-drained grafts just discard this extra fluid with the urine.
  
  And since the original, native pancreas usually still produces adequate exocrine secretions (it just lacks the endocrine secretion insulin), the additional exocrine material is of little consequence in either drainage technique.
  
  Some patients have a little trouble adapting to 'normal' fluid requirements after having been on hemodialysis fluid restrictions for years, but this is usually transient. The increased fluid intake required to replace the losses from a bladder-drained graft is a continuous, daily consideration.
  
  

• 'immunosupressant and diabetes': Some immunosuppresant drugs can affect diabetes, particularly corticosteroids like Prednisone. Existing cases of diabetes as sometimes more difficult to manage, since Prednisone alters metabolism and thus affects blood glucose levels. Other drugs, like Neoral and Prograf (the 'calcineurin inhbitors') are diabetogenic, and can sometimes cause diabetes to develop in previously non-diabetic indivuduals. For more information, see: Risk for Posttransplant Diabetes Mellitus With Current Immunosuppressive Medications.
  
  
• 'kidney transplantation selling': Sales of human organs is illegal in almost every nation on earth, although there is more organ trade in some places than in others. At least one study showed that over the long term, the additonal healthcare costs and the reduced ability to work made the majority of people who sold a kidney less secure financailly than they were before the removal and sale of the kidney. ("Economic and Health Consequences of Selling a Kidney in India," Madhav Goyal, MD, MPH; Ravindra L. Mehta, MBBS, MD; Lawrence J. Schneiderman, MD; Ashwini R. Sehgal, MD, JAMA. 2002;288:1589-1593).
  
  
• ‘chronic pankretites’: chronic pancreatitis is basically a different condition than is the ‘graft pancreatitis’ that often affects transplant patients. Obviously a transplant patient could suffer from chronic pancreatitis also, but the cause of inflammation is usually different in graft pancreatitis.
  
  See: http://www.merck.com/mrkshared/mmanual/section3/chapter26/26c.jsp
  
  
• 'immunosuppressant drugs': See also 'immunosuppressive' drugs, or 'anti-rejection' drugs. The terms are used interchangeably, and vary with the author and the source of the document. Or perhaps look them up by some of the brand names/chemical names: cyclosporine, Neoral, Sandimmune, Gengraf; tacrolimus, FK-506, Prograf; rapamycin, Rapamune; steroids, corticosteroids, prednione, prednisolone, Deltasone, Solu-Medrol; mycophenolate mofetil, CellCept, Myfortic, mycophenolic acid.
  
  There are many other drugs that can be used in special circumstances (as 'induction therapy' or as treatments for various aspects of immunologic processes), but the ones listed are the most commonly used drugs for maintenance immunosuppression.
  
  
• 'PTLD or post-transplant lymphoproliferative disorder': This is a fairly rare but serious blood dyscrasia that sometimes occurs under immunosuppression: the usual treatment is to drastically lower or to completely stop all immunosuppressive drugs. Obviously this action can place the graft at serious risk. But it is about the only choice in order to resolve PTLD. There is a fairly complete article on my other site; see: Posttransplantation Lymphoproliferative Disorders.
  
  
• 'ireland': For locations of worldwide pancreas transplant information and transplant centers, see Insulin-Free World, a great site, loaded with all types of current and historical information.(Virtually all centers that perform pancreas transplants also do kidneys, livers, hearts, etc.)
  
  
• 'steroid induced diabetes': See: 'post-transplant diabetes mellitus', 'post-transplant insulin dependent diabetes mellitus', or 'post-transplant IDDM'. I have an article posted on my other site of interest: Risk for Posttransplant Diabetes Mellitus With Current Immunosuppressive Medications, Matthew R. Weir, MD and Jeffrey C. Fink, MD (AJKD: Vol 34, No 1 (July), 1999: pp 1-13 © 1999).
  
  
• 'cross racial living donor': There is no medical reason to include or exclude any individual from donation if the person’s health is good and the HLA and PRA matches are a success.
  
  There are some HLA patterns that tend to be slightly more prevalent in people of certain ethnic ices, but these differences are by no means universal; it is theoretically possible for a stranger of a different ethnicity to be a closer HLA match that a relative.



• 'how long is the surgical procedure': It can vary greatly from patient to patient. A rough average might be in the neigborhood of 3 to 5 hours, but there are tremendous variances. My kidney + pancreas transplant took nearly 12 hours. You can ask your surgeon in advance, but you may not get a lot of specific answers; once the surgeon is inside and has the donor kidney in his hands, there are still a lot of decisions to be made: selecting the proper place on one of your arteries to attach the graft, etc.



• 'what does the pancreas produce': The pancreas handles a lot of digestive functions. It produces a large amount of bicarbonate ions in solution; these serve to neutralizs a lot of gastric acid as it moves to the duodenum; and the pancreas releases a flood of enzymes, lipase, protease, amylase, which further break down the elements in food.
  
  It also makes insulin and a few other chemicals that are related to the regulation of food and food breakdown products as they enter the blood stream.



• 'recovery after pancrease kidney transplant': This is a highly variable matter. The usual goal at my center is 5-7 days; I was in for 11 while we regulated some drug doses and electrolyte oddities. I have spoken with some people who left the hospital after 3 days, others who were in for 3 weeks.
  
  After the return home it is more or less a matter of letting the surgical incisions heal fully: a few weeks before heavy exercise. The schedule of lab tests is also highly variable. At first I went back for bloodwork every other day, then twice a week, then weekly, bi-weekly, and eventually monthly. I still have to make unplanned lab visits when one of my tests is out of whack and needs to be rechecked.



• 'insulin inhaler': Inhaled insulin has not yet been a approved by the FDA; it could take several more years. The Pfizer product works where oral products do not since it bypasses the digestion and goes to the highly vascularized lungs, and is there absorbed more directly into the bloodstream.
  
  There are still questions as to the effectiveness and stability of dosing, and of the dangers of long-term inhalation of a solid material.
  
  
• 'blood type incompatable': try an internet search for "ABO incompatible." Transplantation across ABO blood groups has been done for a few years now, but it is not the preferred technique in most cases. In order to allow time for the recipient to undergo the required plasmapheresis, a living donor who can be scheduled is required, and a splenecotmy must be performed on the recipient as well as the transplant surgery. For more about the implications of the spleen in graft rejection, do an internet search for "lymphoid organs".
  
  
• 'bk virus': see "bk polyoma virus."
  
  
• 'elevated eosinophils in kidney transplant': Eosinophilia in renal transplant is often indicative of acute rejection episodes; however it’s absence is not necessarily contraindicative of rejection. But there are other causes (other immune activity, allergies, drugs) and there are significant differences between the circulating eosinophil level and the level of eosinophils that infiltrate the renal tissue, as proven by biopsy. It is a significantly complex question that one really needs to ask the doctors directly.
  
  
• 'drug side effects': several searches looked for info on side effects of various anti-rejection drugs; it is hard to generalize about this material so I'd suggest that you look at http://www.transplantbuddies.org/library/library.html#drug where I have posted Consumer Info as well as the Full Prescribing Information on the most common immunosuppressive drugs.
  
  
• 'liver transplant': several searches for liver transplant information; since this site focuses rather exclusively on pancreas-kidney transplants, you might try searching Google or Rush Medical Center, a very complete consumer medical info site.



• 'surrounding tissue pancreatitis': see acinar tissue or pancreatic autodigestion.



• 'pancreatitis' in various terms: Pancreatitis is an inflammation or irritation of the larger mass of pancreatic tissue, the 'acinar' tissue responsible for production of digestive enzymes. It can also affect the lesser qualtity of beta islet cells that produce insulin. In a native pancreas, there are a number of causes for acute or chronic pancreatitis. In 'graft pancreatitis', which applies only to transplanted organs, a number of different causes may also need consideration, anything from infections to blood flow problems could be a possiblity. Treatment will vary depending on the exact cause and whether the pancreas graft is exocrine drained enterically or to the bladdder.



• 'fty': The drug FTY-720 is an newer immunosuppressant, not yet in wide use.



• 'renal diet': I mention renal diets, but only in very general terms since renal diets vary widely for each patient, and vary according to periodic lab tests; there is no one-size-fits-all renal diet. A consult with a physician or a qualifed renal dietician is the only safe way to go about it.('Renal dietician' is a true specialty: I have had hospital dieticians who seem to know absoutely nothing about renal diets at all.)



• 'proteinuria': This term simply describes the presence of unusual amounts of protein (specifically, albumin) in the urine. Some small amouts of urine protein are considered relatively normal (less than 150 mg/24 hours). Heavy proteinuria can show amounts of more than 6,000 mg/24 hours.
  Proteinuria is not a disease; it is a symptom. A number of different things can be the underlying cause of proteinuria; everything from urinary tract infection to glomerular damage. Whatever the cause, it needs to be monitored by a physcian.



• 'allograph bgii': This is a bit tricky since the 'bg' (probably 'BG II') initials have a lot of different meanings. I might suggest that one use could be to describe the not-so-common "Bennett-Goodspeed antigens." These are highly specific antigens which, to my limited understanding, appear as HLA antigenic proteins, but on the surface of erythrocytes, red blood cells, not on the surface of leukocytes, white blood cells.
  But there are a lot of other possibilites for the 'bg' initials: there are some unusual designations for monoclonal antibodies that use 'bg' as well as about a dozen or more uses of those letters in medical literature.
  (The word 'allograph' should be spelled 'allograft'.)



• 'cortex dialysis graft': See: Gore-Tex Medical Products.



• 'lab values for pancreatic enzymes': See amylase and lipase. (also 'protease')



• 'functions of the pancreas': The pancreas has two basic functions: 1) to secrete the digestive enzymes needed to fully breakdown food in the duodenum and the small intestine (also the bicarbonate ions needed to neutralize gastric acid); and 2) to secrete insulin, a hormone needed for proper glucose metabolism (see islets of Langerhans). In diabetic patients, a transplanted pancreas is needed only for its insulin production; the native pancreas continues to produce the digestive enzymes.



• 'what is the green liquid that leaks from the pancreas': This question is a mystery to me: How does one see a pancreatic secretion since the organ is wholly inside the body and has no direct outlet?



• 'cytoxin': try 'cytoxan,' brand name for cyclophosphamide, a chemotherapy drug with immunosuppressive properties. Not to be confused with 'cytotoxic' as in 'cytotoxic t-cells'.



• 'bk virus': 60-80% of US adults are antibody positive for BK polyoma virus. The latent virus often become active under immunosuppression, and can cause elevated serum creatinine from viral nephropathy. For more, search the net or search www.ajkd.org and read the abstracts. One full text article is posted here.
  
  
• 'renal fibrosis': there are different loci and different degrees of fibrosis that can affect the kidney: tubulointerstitial fibrosis, cortical interstitial fibrosis, etc. Usually biopsy proven, the degree and progression is highly individualized.



• 'hyperglycemia': largely due to steroids and calcinurin inhibitors, hyperglycemia and post transplant diabetes mellitus is not uncommon at some point after transplant. I have one article posted here
  
  
• 'craig mismatch': check your original source, I can't think of anything that sounds like this at all.



• 'microphage': see 'macrophage' with an A, not an I.
  
  
• ‘tying off pancreatic duct’: ligation of the pancreatic duct is not really a viable technique in most cases, it often results in pancreatitis or loss of acinar tissue. ‘Duct injection’ was used in some early pancreas transplants as a way to handle the exocrine secretions, but it has largely been abandoned in favor of enteric drainage since the overall health of the acinar pancreas is often adversely affected.



• ‘microphages’: see macrophages