胰液膀胱引流式胰肾联合移植长期存活15例随访

Long-term survival following simultaneous pancreas-kidney transplantation with bladder drainage:Follow-up in 15 cases

背景:胰肾联合移植是治疗1型糖尿病合并终末期肾病的首选疗法,但由于移植风险高,并发症多,国内开展并不广泛。目的:总结胰液膀胱引流式胰肾联合移植长期存活的临床经验,观察其远期效果并分析影响因素。方法:对15例患者行胰液膀胱引流式胰肾联合移植,均采用心脏死亡的供体。HLA配型平均为2.13。均选择胰液膀胱引流式和体循环回流血管吻合方式,免疫抑制剂方案均用他克莫司,霉酚酸酯和泼尼松治疗。观察移植后患者移植物肾功能、血糖、淀粉酶等及并发症。结果与结论:最短随访8.5个月,最长随访105.5个月,平均住院时间为37.7(13～82)d。移植后13例患者胰腺功能恢复,2例于移植后即切除移植胰腺。移植后除1例患者肾脏功能延迟恢复外,其余患者肾脏功能立即恢复。2例患者因慢性排斥反应丢失移植胰腺和移植肾。移植后主要并发症为排斥反应,返流性胰腺炎和血栓形成。提示胰肾联合移植是治疗终末期糖尿病并发肾功能衰竭的一种安全而有效地治疗方法,其远期效果理想,完善的围移植期管理、预防和及时处理并发症、合理应用免疫抑制剂是影响患者和移植物长期存活的重要因素。

BACKGROUND：Simultaneous pancreas-kidney transplantation （SPKT） is a valid therapeutic option for the diabetic end stage nephropathy patients. However,there are few centers carry out SPKT due to transplantation complex and various complications. OBJECTIVE：To summarize our clinical experience of long-term surviving in SPKT,and to discuss the long-term outcome and its impact factors of SPKT with bladder drainage of pancreatic secretion. METHODS：The study population included 15 patients who underwent SPKT. The mean human leukocyte antigen match was 2.13. SPKT was always performed using bladder drainage and vascular anastomoses to the systemic circulation. Immunosuppressive treatment consisted of anti-lymphocyte globulin induction followed by tacrolimus,mycophenolate mofetil,and prednisone. The renal function,blood sugar,amylzyme and complications were observed after transplantation. RESULTS AND CONCLUSION：The mean hospital stay was 37.7 （13-82） days. After surgery,pancreas functions of 13 patients recovered well,while 2 cases＇ pancreas was removed immediately. Except for one case＇s renal delayed graft function,all the other renal function recovered immediately. After a mean follow-up of 48.2 （8.5-105.5） months,because of chronic rejection,2 cases lost their pancreas and kidney functions. Major complications included rejection,reflux pancreatitis and thrombosis. SPKT is a safe but valid therapeutic option for the diabetic end stage nephropathy patients. A perfect perioperative management,prevention and in time manipulation of complications,and suitable utilization of immunosuppressant are key factors affect long-term survivals of transplantation.