不同年龄组供者胰肾联合移植安全性和有效性分析

Efficacy analysis of simultaneous pancreas and kidney transplantation from donors of different ages

目的探讨不同年龄组胰腺供者胰肾联合移植的安全性和有效性。方法2016年9月至2020年6月广州医科大学附属第二医院共完成146例胰肾联合移植,按胰腺供者年龄将146例受者分为三组:<18岁组(18例)、18~39岁组(85例)和≥40岁组(43例)。随访1~45个月,分别监测三组受者术后不同时间的移植胰腺、肾脏的功能指标,统计内科和外科并发症的发生率,比较三组受者术后1.3年受者、移植胰腺和移植肾存活率。结果三组受者血清肌酐在术后10 d达到正常水平,糖化血红蛋白在术后6个月达稳态,三组受者术后6个月在血清肌酐、空腹胰岛素、空腹C肽、空腹血糖、糖化血红蛋白和血淀粉酶方面的差异均无统计学意义(均P>0.05)。内科并发症以围手术期感染为主。三组的急性排斥反应均以胰腺十二指肠排斥为主,三组在胰腺十二指肠、肾和胰腺合并肾这三种形式的急性排斥反应发生率差异均无统计学意义(均P>0.05)。外科严重并发症以肠漏、动脉血栓及静脉血栓为主。三组受者在肠漏、动脉血栓、静脉血栓的发生率差异均无统计学意义(均P>0.05)。三组受者1年.3年受者存活率均分别为85.0%.95.0%.90.4%;1年、3年移植胰腺存活率均分别为85.0%.91.0%.85.8%;1年、3年移植肾存活率均分别为85.0%.95.0%.85.8%;1年.3年死亡删失的移植胰腺存活率分别均为100%,95.8%、90.6%,死亡删失的移植肾1年、3年存活率均分别为100%、100%.98.5%,三组受者、移植胰腺和移植肾存活率的组间差异均无统计学意义(均P>0.05)。结论在严格的供者筛选和精细的手术操作基础上,使用儿童及一定年龄限制的高龄供者胰腺,具有与成人供胰相似的临床结局。高龄供者需谨慎评估,长期的随访结果需进一步观察。

Objective To explore the eficacy and safety of simultancous pancreas and kidney transplantation(SPK)from donors of different ages.Methods A total of 146 SPK operations were completed at Second Afiliated Hospital of Guangzhou Medical University from September 2016 to June 2020.The donors were divided into three groups:<18 yrs group(18 cases),18 to 39 yrs group(85 cases)and 40 yrs and up group(43 cases).The similarities and differences of SPK efficacy were analyzed for different ages.Results During a fllowup period of(1~45)months,no stisically significant differences existed in postoperative recovery time,transplanted renal function or transplanted pancreatic function.Graft function at 10 days post-operation normalized and no statistical difference existed annong three groups.Glycosylated hemoglobin of three groups at 6 month showed no statistical difference among three groups.Medical complication was perioperative infection.And acute rejection was manifested as pancreas duodenum rejection.The incidence of three groups were 0.06,0.22 and 0.16;the incidence of kidney acute rejection 0.11,0.05 and 0.09;the incidence of combined acute pancreas and kidney rejection 0.11,0.05 and 0.09 and three groups showed no statistical difference.Severe surgical complication was poor healing of incision.The incidence of three groups were 0.11,0.13 and 0.14 and the major serious complications included intestinal leakage,arterial thrombosis and venous thrombosis.The incidence of intestinal leakage in three groups were 0,0.01 and 0.05,arterial thrombosis 0,0.01 and 0.05 and venous thrombosis 0,0 and 0.05 respectively.Thus no statistical difference existed in the incidence of surgical complications.Patient survival rates in 1-year and 3-year post-transplantation in three groups were 85.0%,95.0%and 90.4%;pancreatic graft survival rates 85%,91%and 85.8%;despite death,the pancreatic graft survival rates were 100%,95.8%and 90.6%;kidney graft survival rate 85.0%,95.0%and 90.4%.Conclusions After thorough evaluations,detailed surgical procedures and refined surgical skills,SPK from pediatric and elderly donors with certain age limits has similar clinical outcomes to that from adult donors.Besides,elderly donors still need to be carefully evaluated and long term follow-ups should be further observed.