Experience with 500 simultaneous pancreas-kidney transplants
Experience with 500 simultaneous pancreas-kidney transplants
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DOI：
10.1097/00000658-199809000-00002
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发表时间：
1998-09-01
影响因子：
9
通讯作者：
Pirsch, JD
中科院分区：
文献类型：
--
作者：
Sollinger, HW;Odorico, JS;Pirsch, JD
方法自1985年12月至1997年10月，在美国威斯康星州进行了500例胰肾联合移植（SPK）。388例采用膀胱引流（BD），112例采用肠内引流（艾德）。所有胰腺移植在UW solution.ResultsPatient生存率在1，5，10年分别为96.4%，88.6%，76.3%。肾功能分别为88.6%、80.3%和66.6%，胰腺功能分别为87.5%、78.1%和67.2%。胰腺血栓形成发生在3 - 4例（0.6%-0.8%）和原发性无功能1例（0.2%）。肾脏急性肾小管坏死率为4.2%。24%的病例需要从艾德转为艾德。肠内转流的主要适应症为尿漏（14%）、尿道炎和尿外渗（7%）和慢性血尿（3%）。艾德和ED之间的1年移植物存活率没有差异。胰腺丢失的主要原因是45例患者的排斥反应和27例患者的功能正常的移植物死亡。自1995年6月以来。霉酚酸酯用于免疫抑制（n = 109），其1年生存率为：患者98.1%，肾脏94.2%，胰腺93.1%。类固醇耐药排斥反应从48%下降到15%。结论本系列代表了世界上最大的SPK经验，包括最长的随访艾德胰腺移植。十年移植存活率超过所有其他移植，除了HLA相同的活体相关移植。该系列证实SPK对于选定的糖尿病肾衰竭患者是一种非常成功的手术。
MethodsFrom December 1985 to October 1997, 500 simultaneous pancreas-kidney transplants (SPKs) were performed at the University of Wisconsin. Bladder drainage (BD) was used in 388 and enteric drainage (ED) in 112. All pancreas transplants were presented in UW solution.ResultsPatient survival at 1, 5, and 10 years was 96.4%, 88.6%, and 76.3%. kidney function, 88.6%, 80.3%, and 66.6%; and pancreas function, 87.5%, 78.1 %, and 67.2%. Thrombosis of the pancreas occurred in three to four (0.6% to 0.8%) and primary nonfunction in one (0.2%). There was a 4.2% acute tubular necrosis rate for the kidney. Conversion from ED to ED was required in 24% of cases. Primary indications for enteric conversion (EC) were leak (14%), urethritis and extravasation (7%), and chronic hematuria (3%), No graft was lost as a resuit of EC. There was no difference in 1-year graft survival between ED and ED. Leading causes of pancreas loss were rejection in 45 patients and death with a functioning graft in 27 patients. Since June 1995. mycophenolate mofetil was used for immunosuppression (n = 109), One-year survival rates with mycophenolate mofetil are patient, 98.1%; kidney, 94.2%; and pancreas, 93.1%. Steroid-resistant rejections de creased from 48% to 15%.ConclusionsThis series represents the world's largest experience with SPK, including the longest follow-up for ED pancreatic transplants. Ten-year graft survival rates exceed those of all other transplants, with the exception of HLA-identical living-related grafts. This series confirms that SPK is a highly successful procedure for selected diabetic patients with renal failure.