Public Defence: Rune Horneland

Cand.med. Rune Horneland at Institute of Clinical Medicine will be defending the thesis “Benefits and Challenges with Exocrine Drainage Through Native Duodenum in Whole Organ Pancreas Transpolantation” for the degree of PhD (Philosophiae Doctor).

Trial Lecture – time and place

See Trial Lecture.

Adjudication committee

  • First opponent: Professor George William Burke III, University of Miami
  • Second opponent: Associate Professor Jens G. Hillingsø, University of Copenhagen
  • Third member and chair of the evaluation committee: Professor Kirsten Krogh-Sørensen, University of Oslo

Chair of the Defence

Professor John Torgils Vaage, University of Oslo

Principal Supervisor

Group Leader Einar Martin Aandahl, Oslo University Hospital

Summary

Pancreas transplantation (PTX) is the only treatment that offer diabetes mellitus type I patients long-term insulin independence. PTX is performed as PTX alone (PTA) or in combination with a kidney transplant (SPK). The lack of biochemical markers have made rejection (RJ) of the pancreas graft (TX-P) difficult to monitor. Traditionally, the transplanted kidney (TX-K) or the transplanted duodenal segment (TX-D) have been used as sentinel organs for RJ of the TX-P, but it has not been addressed whether there is a true concordance in RJ between the organs. To facilitate endoscopic access (EUS) for biopsies from the pancreas and the duodenal segment, we changed the technique from a duodenojejunal anastomosis (DJ) to a duodenoduodenal anastomosis (DD). We compared 40 PTX with DD (DD-PTX) with 40 PTX with DJ (DJ-PTX) after the switch in technique in 2012. We found both the DD and EUS safe and feasible, but observed a non-significantly higher rate of vein thrombosis (VT) and graft loss (GL) in the DD-group. We then did a more comprehensive analysis of 117 consecutive DD-PTX and 179 DJ-PTX. We found no significant differences between the DD- or DJ-groups with regards to reoperations, VT, early GL and patient survival. However, rejection rate (RR) causing GL was significantly higher in PTA compared to SPK, leading to 1- and 3-years GS in the DD-PTA of 74% and 64% vs 90% and 83% in the DD-SPK. In the last study, we sampled 113 paired biopsies from TX-P and the duodenal segment (TX-D) in 67 patients. RR in PTA was 40% vs 7% in SPK. We found 9% sensitivity and 96% specificity for the TX-D to detect/rule out a RJ in TX-P. In summary, this thesis show that DD-PTX is safe and feasible and it allows for biopsies to be obtained endoscopically from TX-P and TX-D. The TX-D seems not to be a reliable sentinel organ for the TX-P. Whether EUS and meticulous RJ-monitoring can be translated into better long-term results is yet to be shown in future studies.

Additional information

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Published Sep. 30, 2019 10:42 AM - Last modified Oct. 4, 2019 1:14 PM