Pancreas Transplantation From Living Donors: A Single Center Experience of 20 Cases
Pancreas Transplantation From Living Donors: A Single Center Experience of 20 Cases
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DOI：
10.1111/ajt.13738
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发表时间：
2016-08-01
影响因子：
8.8
通讯作者：
Han, D. J.
中科院分区：
文献类型：
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作者：
Choi, J. Y.;Jung, J. H.;Han, D. J.
活体供体胰腺移植(LDPT)与已死亡供体胰腺移植(DDPT)相比，具有更好的配型、缺血时间和等待时间等优点。对于患有终末期肾病的糖尿病患者来说，它仍然是一个有吸引力的选择。我们回顾了1992年10月至2015年3月在峨山医学中心进行的20例LDPT。单纯胰腺移植(PTA)6例(30%)，胰肾联合移植(SPK)6例(70%)。供受者关系为父母7人(35%)，兄弟姐妹6人(30%)，配偶6人(30%)，堂兄弟姐妹1人(5%)。术后1、3、5、10年移植肾存活率分别为91.7%、83.3%、83.3%和83.3%，PTA组分别为50%、33.3%、16.7%和16.7%(p=0.005)。移植失败的原因：SPK组1例，血栓形成1例，排斥反应1例；PTA组移植失败2例，血栓形成1例，反流性胰腺炎1例，慢性排斥反应1例。在胰腺外分泌引流方面，2例(25%)移植物维持膀胱引流功能，所有移植物均维持肠道引流功能。7例(35%)供者发生轻微胰液漏，1例因术后血肿再次手术。大多数捐赠者维持正常的血糖和正常的肾功能。然而，两名捐献者(在捐献后1个月和90个月)发生了糖尿病，并接受了口服降糖药治疗。由于依从性差和与膀胱引流相关的问题，PTA接受者的移植物存活率比SPK差。通过应用严格的供者标准，可以将供者的手术和代谢并发症的发生率降至最低。在这项对20例患者的研究中，作者发现活体供体胰腺移植的移植物存活率低于活体供体胰腺肾移植，但后者的移植物存活率与已故供体胰腺肾移植的移植物存活率相当。
Living donor pancreas transplantation (LDPT) has several advantages over deceased donor pancreas transplantation (DDPT), including better HLA matching, shorter ischemic time, and shorter waiting time. It remains an attractive option for diabetes mellitus (DM) patients with end stage renal disease. We reviewed 20 cases of LDPT performed in Asan Medical Center between October 1992 and March 2015. Six cases (30%) were pancreas transplantation alone (PTA), and the rest (70%) were simultaneous pancreas and kidney transplantation (SPK). Relations of donor and recipient were parents in 7 (35%), siblings in 6 (30%), spouse in 6 (30%), and cousin in 1 (5%). Graft survival in SPK at 1, 3, 5, and 10 years was 91.7%, 83.3%, 83.3%, and 83.3%, respectively, and that in PTA recipients was 50%, 33.3%, 16.7%, and 16.7%, respectively (p = 0.005). Causes of graft failure in SPK were thrombosis (one case), and rejection (one case), whereas those in PTA were noncompliance (two cases), thrombosis (one case), reflux pancreatitis (one case), and chronic rejection (one case). In terms of pancreas exocrine drainage, two grafts (25%) maintained their function in bladder drainage, while all grafts maintained in enteric drainage p < 0.05). Seven (35%) donors experienced minor pancreatic juice leakage and one underwent reoperation due to postoperative hematoma. Most donors maintained normoglycemia and normal renal function. However, two donors developed DM (at 1 and 90 months postdonation), and were treated with oral hypoglycemic agents. Graft survival in PTA recipients was poorer than in SPK due to poor compliance and bladder drainage-related problems. The surgical and metabolic complication rates of donors can be minimized by applying strict donor criteria. Therefore, LDPT with enteric drainage is an acceptable treatment for SPK.In this study of 20 patients, the authors find poor graft survival in living donor pancreas transplantation when compared with living donor pancreas-kidney transplantation, but graft survival in the latter was comparable with deceased donor pancreas-kidney transplantation.