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Title: Assessment and optimisation of the pancreas allograft
Author: Dholakia, Shamik
Awarding Body: University of Oxford
Current Institution: University of Oxford
Date of Award: 2019
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Background In this thesis, I have sought to improve the understanding of how pancreases are assessed with a particular focus on organ steatosis and allograft pancreatitis. Whole organ pancreas transplantation is a transformative treatment option, but despite the benefits since its inception, little evolution has been made tackling the change in donor habitus. With continued high morbidity and falling rates of referral, pancreas transplantation remains a niche treatment rather than a mainstay for patients with diabetes. Aim The key aim of the thesis is to assess current trends in pancreas organ utilisation nationally, and see how these compare with other international programs. I have started off by identifying areas of optimisation and considering factors that may be relevant, and I have then applied particular focus on assessment in regards to pancreas steatosis and associated allograft pancreatitis, thereafter focusing on how better to assess and optimise patients with this morbidity. Results • Lack of pancreases is not the primary issue when considering utility. Assessment of fatty pancreases in the context of organ steatosis is a key factor in the decision-making process with a very high percentage of donor organs assessed as unfit for purpose. • Pancreas steatosis is common, heterogeneous and focal, with the use of MRI being quantitative and potentially clinically useful. • Allograft pancreatitis is a common morbidity with an incidence of 44%. Day 5 CRP appears to be a suitable surrogate marker, with alternative methods of assessment also possible with further work (FACBC and glutathione). • Inflammatory patterns suggest allograft pancreatitis may be a distinct process to native pancreatitis with classical monocytes and macrophages playing an important role. Conclusion Current donor utilisation and methods of assessment are imprecise, in particular, the causal associations between pancreas steatosis and the adverse outcome remains unproven. The need to minimise postoperative morbidity has clear merit with early organ dysfunction, due to allograft pancreatitis being shown to be associated with long-term graft loss. There is a clear clinical need to identify and test strategies that abrogate early graft inflammation in order to improve outcome.
Supervisor: Ploeg, Rutger ; Sharples, Edward Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available