Dr. 安德鲁Posselt is a transplant surgeon at UCSF where he specializes in adult and pediatric kidney, 肝脏和胰腺移植. 他领导着胰腺 胰岛移植计划 同时也是 UCSF减肥手术中心. 除了照顾病人, Posselt十大赌博靠谱网络平台了胰岛移植的研究, the mechanisms behind the tolerance or rejection of transplanted tissue and the metabolic and biochemical consequences of bariatric surgery. Posselt于2003年加入加州大学旧金山分校.
You have an interesting range of credentials; you trained in internal medicine, 免疫学和外科. 这一切都是为了让你成为一名移植外科十大赌博平台排行榜而计划好的吗?
不是真正的. I got interested in surgery because as a kid one of my hobbies was taxidermy and I really enjoyed the technical and anatomic aspects of it. I went to medical school at the University of Pennsylvania and worked in the transplant lab because I enjoyed the surgical aspects of the field. 我最终完成了关于胰岛移植的博士论文. 虽然我很喜欢手术, I opted for a residency in internal medicine because I had a great experience on my medicine externship as a medical student and felt that the specialty would allow me to become the best doctor possible. 不过我也喜欢免疫学, so my ultimate plan was to train as a hematologist and specialize in bone marrow transplantation.
我来加州大学旧金山分校是为了我的医学实习，虽然我非常享受, 我真的很想念手术的技术和程序方面. 然后, 就在我读完这本书准备参加血液学研究的时候, 我和Dr. James Ostroff是一位胃肠病学家，他做过很多内窥镜手术. It again reminded me of my interest in procedurally-oriented specialties and I finally decided that I really wanted to be a surgeon. 离截止日期还有一周的时间, I applied through the match and was fortunate enough to get an intern spot here at UCSF in the general surgery program.
回去当实习生难吗?
Not at all; I loved it. 我很高兴. I was finally able to be in the OR (operating room) and the clinical work was easier for me because of my prior experiences as a medicine resident. 实习期快结束时，我开始和 Not at all; I loved it. 我很高兴. I was finally able to be in the OR (operating room) and the clinical work was easier for me because of my prior experiences as a medicine resident. 实习期快结束时，我开始和 Dr. 彼得股票他是另一位移植外科十大赌博平台排行榜，在我之前领导了胰岛项目.
当你在医学院的时候，胰岛移植是一个遥远的梦想. 什么时候它们成为糖尿病患者的可行选择?
大概是在2000年. 当时，阿尔伯塔大学的一个小组，由Dr. 詹姆斯·夏皮罗, published a paper in the New England Journal of Medicine describing a new protocol that reproducibly allowed patients to achieve insulin independence. 他通过改变免疫抑制方案实现了这一目标, 供选择, 还有胰岛隔离过程. This generated a lot of excitement because it provided a less invasive islet replacement strategy that pancreas transplantation. 不幸的是, this excitement was short-lived because we eventually discovered that after a year or two the transplanted islets started failing and the patients had to go back on insulin.
问题是什么??
没有人真正知道，但它似乎是免疫和非免疫破坏的结合. 尽管如此, people started devising better techniques for isolating donor islet cells and different immunosuppressive regimens and patient outcomes started improving again.
谁是胰岛移植的候选者?
The ones who benefit most are the diabetics who have really difficult-to-control blood sugars. Usually the most significant and dangerous issue they're dealing with is low blood sugar levels. Their blood sugar can drop unexpectedly and if it goes too low they could lose consciousness If this happens while they're driving it can have disastrous consequences. 如果在睡觉时发生, 患者可能因持续低血糖而无法醒来并死亡. 不幸的是, 患糖尿病的时间越长, 你就越不知道何时会出现低谷. 所以这样的人，控制力很差，才是最好的人选. A diabetic who's on a stable insulin regimen with their blood sugars and AIC hemoglobin well controlled won't benefit as much from a transplant.
移植手术能让他们停止注射胰岛素吗?
这就是我们的目标. But even if they don't come off insulin, they have a much easier time controlling their blood sugars. 胰岛提供一些胰岛素分泌的基线，所以低水平消失了. 这真的很神奇.
有多少移植患者完全不需要胰岛素?
这在某种程度上是中心问题. 在加州大学旧金山分校，我们目前的胰岛素独立率超过80%.
这些病人会在他们的余生中不需要胰岛素吗?
可能不是, 但大约50- 60%的患者在移植后5年内仍能保持无胰岛素状态, 这和接受过胰腺移植的人的发病率差不多吗. 所以，虽然它不能治愈所有的糖尿病患者，但它肯定能治愈一些人. 显然还有很多工作要做，但我们已经取得了长足的进步.
胰岛移植与胰腺移植相比如何?
胰腺移植可能会更好地控制血糖, 但这个过程相当复杂，充满了潜在的并发症. An islet transplant takes 40 minutes with just local anesthesia; a pancreas transplant typically takes 4-8 hours under general anesthesia — you're in the hospital for seven to 10 days and if there are complications, 你可能会在那里待更长的时间. 除了, 例如，许多病人不适合做手术, 在我们中心, 截止年龄是45岁, 而且患者必须没有严重的心脏病.
患有严重糖尿病的人可以接受胰岛移植吗?
目前，获得胰岛移植的唯一途径是通过临床试验. Medicare will only cover the procedure if the patient is part of a trial funded by the National Institutes of Health. UCSF is part of an ongoing multicenter trial that will hopefully demonstrate that islet transplants are a viable therapy. 这项研究的最终目标是获得食品和药物管理局的批准. 一旦发生这种情况, private insurers will be more likely to cover it and more people will be able to undergo the procedure.
你也做减肥手术，对吧?
我们给严重超重的人做减肥手术. 但越来越普遍, we are doing bariatric surgery on patients who need a transplant but are not candidates due to their weight. 肥胖在等待移植的病人中很常见, 如果一个病人被认为病情严重, 或者病态肥胖, 他们通常不能接受器官，直到他们失去足够的体重. 在过去，我们会告诉他们需要减肥. But they usually are not able to due to their chronic disease and fatigue associated with it. 所以几年前我们开始对这些病人进行减肥手术. 他们实际上做得很好，很多人已经接受了移植.
你会使用典型的减肥方法吗?
我们通常会做袖式胃切除术, 和标准的胃旁路手术有什么不同. 在旁路手术中，胃部会形成一个小袋，肠道与之相连. The small pouch size gives a feeling of satiety even with small amounts of food and so the patient does not eat as much. 有袖子的, you cut out most of the stomach and make it into a tube; it still narrows the stomach, 所以病人不会吃那么多. But it's easier perform than a bypass and it allows the patient to take more medications than if they just have a tiny pouch for a stomach. So it’s good for patients who are sicker, and like transplant patients, are on a lot of meds. 他们的减肥效果很好.
这是一个不寻常的节目吗?
我不知道还有其他中心在这个病人群体中做过这个手术, 所以我想是的. 但人们对此非常感兴趣, and I think a number of centers will begin to perform this procedure in transplant candidates in the near future.
我知道你会说捷克语、德语、法语和西班牙语. 你是如何掌握多种语言的?
I was born in the Czech republic but my family left the country a couple of years after the Russian occupation, 当我八岁的时候. We emigrated to what was then West Germany and lived there for two years before moving to Toronto. 我的父母最终回到了德国，现在还在那里. 所以，我知道捷克语、德语，当然，通过搬到每个国家，我也知道英语. I learned Spanish and French through language courses in high school that I still seem to remember, 虽然不是很好.
你最喜欢在加州大学旧金山分校工作的哪一点?
我喜欢你身边有很多优秀的人, 所以如果你需要什么建议, 你总能找到这个领域的专家. 这是一个支持性的环境. 我也很喜欢和学生一起工作, residents and fellows and find it very rewarding to contribute to their education and watch their progress.
