Eric Martinez M.D.

Pham, P. H., L. N. Stalter, E. J. Martinez, J. F. Wang, B. M. Welch, G. Leverson, N. Marka, T. Al-Qaoud, D. Mandelbrot, S. Parajuli, H. W. Sollinger, D. Kaufman, R. R. Redfield and J. S. Odorico (2021). “Single center results of simultaneous pancreas-kidney transplantation in patients with type 2 diabetes.” Am J Transplant 21(8): 2810-2823.

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Studies have found similar outcomes of Simultaneous Pancreas-Kidney transplantation (SPKT) in patients with Type 2 (T2D) and Type 1 diabetes (T1D). However, there are scarce data evaluating the association of recipient factors such as age, BMI, or pretransplant insulin requirements with outcomes, thus the criteria for the optimal recipient selection remains unclear. In this study, 284 T1D and 39 T2D patients, who underwent SPKT between 2006 and 2017 with 1 year of follow-up at minimum, were assessed for potential relationship of pretransplant BMI and insulin requirements with posttransplant diabetes and pancreatic graft failure. Kaplan-Meier analysis showed similar rates of freedom from posttransplant diabetes (94.7% T2D vs. 92.3% T1D at 1 yr, and 88.1% T2D vs. 81.1% T1D at 5 yrs) and graft survival (89.7% T2D vs. 90.4% T1D at 1 yr, and 89.7% T2D vs. 81.2% T1D at 5 yrs). There was no significant association between BMI or pretransplant insulin requirements with posttransplant diabetes occurrence in either T1D (p = .10, .43, respectively) or T2D (p = .12, .63) patients in the cohort; or with graft failure (T1D: p = .40, .09; T2D: p = .71, .28). These observations suggest a less restricted approach to selective use of SPKT in patients with T2D.

Pham, P.H., Stalter, L.N., Martinez, E.J., Wang, J.F., Welch, B.M., Leverson, G., Marka, N., Al-Qaoud, T., Mandelbrot, D., Parajuli, S., Sollinger, H.W., Kaufman, D., Redfield, R.R., 3rd and Odorico, J.S. (2020). “Large Single Center Results of Simultaneous Pancreas-Kidney Transplantation in Patients with Type 2 Diabetes.” Am J Transplant Dec 22. [Epub ahead of print].

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Studies have found similar outcomes of Simultaneous Pancreas-Kidney transplantation (SPKT) in patients with Type 2 (T2D) and Type 1 diabetes (T1D). However, there are few data evaluating the association of recipient factors such as age, BMI, or pre-transplant insulin requirements with outcomes, thus the criteria for the optimal recipient selection remains unclear. In this study, 284 T1D and 39 T2D patients, who underwent SPKT between 2006-2017 with 1 year of follow-up at minimum, were assessed for potential relationship of pre-transplant BMI and insulin requirements with post-transplant diabetes and pancreatic graft failure. Kaplan-Meier analysis showed similar rates of freedom from post-transplant diabetes (94.7% T2D vs. 92.3% T1D at 1 yr, and 88.1% T2D vs. 81.1% T1D at 5 yrs) and graft survival (89.7% T2D vs. 90.4% T1D at 1 yr, and 89.7% T2D vs. 81.2% T1D at 5 yrs). There was no significant association between BMI or pre-transplant insulin requirements with post-transplant diabetes occurrence in either T1D (p = 0.10, 0.43, respectively) or T2D (p = 0.12, 0.63) patients in the cohort; or with graft failure (T1D: p = 0.40, 0.09; T2D: p = 0.71, 0.28). These observations suggest a less restricted approach to selective use of SPKT in patients with T2D.

Testa, G., G. J. McKenna, J. Bayer, A. Wall, H. Fernandez, E. Martinez, A. Gupta, R. Ruiz, N. Onaca, R. T. Gunby, A. R. Gregg, M. Olausson, E. C. Koon and L. Johannesson (2020). “The Evolution of Transplantation From Saving Lives to Fertility Treatment: DUETS (Dallas UtErus Transplant Study).” Ann Surg Jul 9. [Epub ahead of print.].

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OBJECTIVE: We report the results of the first 20 uterus transplants performed in our institution. SUMMARY BACKGROUND DATA: Uterus transplantation (UTx) aims at giving women affected by absolute uterine-factor infertility the possibility of carrying their own pregnancy. UTx has evolved from experimental to an established surgical procedure. METHODS: The Dallas Uterus Transplant Study (DUETS) program started in 2016. The uterus was transplanted in orthotopic position with vascular anastomoses to the external iliac vessels and removed when 1 or 2 live births were achieved. Immunosuppression lasted only for the duration of the uterus graft. RESULTS: Twenty women, median age 29.7 years, enrolled in the study, with 10 in phase 1 and 10 in phase 2. All but 2 recipients had a congenital absence of the uterus. Eighteen recipients received uteri from living donors and 2 from deceased donors. In phase 1, 50% of recipients had a technically successful uterus transplant, compared to 90% in phase 2. Four recipients with a technical success in phase 1 have delivered 1 or 2 babies, and the fifth recipient with a technical success is >30 weeks pregnant. In phase 2, 2 recipients have delivered healthy babies and 5 are pregnant. CONCLUSIONS: UTx is a unique type of transplant; whose only true success is a healthy child birth. Based on results presented here, involving refinement of the surgical technique and donor selection process, UTx is now an established solution for absolute uterine-factor infertility.