应用现代免疫抑制剂减少胰-肾联合移植外科并发症

Decreasing surgical risk with current immunosuppressive agent for simultaneous pancreas kidney transplantation

目的：提高胰－肾联合移植的治疗效果。 方法：对１ 例胰岛素依赖型糖尿病合并尿毒症患者施行膀胱引流式尸体胰十二指肠－肾一期联合移植术。术后采用包括抗淋巴细胞诱导的四联序贯免疫抑制方案，维持免疫抑制采用包括环孢素，强的松和骁悉的三联方案。 结果：术后第４ 天，移植肾和胰腺功能恢复良好，转为胰岛素非依赖，血肌酐、尿素氮及空腹血糖降至正常。未发生外科并发症。 结论：胰十二指肠－肾一期联合移植术是治疗胰岛素依赖型糖尿病合并尿毒症一种行之有效的手段。

To present the treatment of insulin dependent diabetes mellitus patient with end stage kidney disease. Methods Cadaver donors simultaneous pancreaticoduodenal and kidney transplantation have been performed for one uremic patient with insulin dependent diabetes mellitus.Bladder drainage was used for management of pancreas exocrine secretions. After operation, employ quadruple drugs immunosuppression with anti lymphocyte induction with a monoclonal antibody. Maintenance immunosuppression is triple therapy consisting of a calcineurin inhibitor (cyclosporine), corticosteroids, and an anti metabolite (MMF). Results The renal and pancreatic graft obtained normal function and became insulin independent. The serum creatinine and BUN as well as fasting blood sugar decreased to normal levels four days after the operation. Perioperative surgical complication was not happened. Conclusions Combined pancreas kidney transplantation is a effect treatment toⅠtype diabetics and nephropathy.