The First Simultaneous Kidney–Adrenal Gland–Pancreas Transplantation: Outcome at 1 Year
The First Simultaneous Kidney–Adrenal Gland–Pancreas Transplantation: Outcome at 1 Year
复制标题
首例同时肾-肾上腺-胰腺移植：一年后的结果
DOI：
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发表时间：
2013
影响因子：
8.8
通讯作者：
Lionel Badet
中科院分区：
文献类型：
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作者：
J. Vouillarmet;F. Buron;C. Houzard;M.;C. Chauvet;M. Brunet;Charles Thivolet;Emmanuel Morelon;Lionel Badet
肾上腺功能不全是一种罕见但危及生命的疾病。替代疗法有时无法预防急性肾上腺危象，并且通常不会导致健康恢复。我们在此报告了一例33岁1型糖尿病伴自身免疫性肾上腺功能不全患者的首次肾-肾上腺-胰腺联合移植的1年结局。在正常血管条件下，将左肾上腺和肾移植物整体缝合在左髂血管上，并将胰腺移植物缝合在右髂血管上。免疫抑制方案未通过添加肾上腺进行修改。我们没有观察到额外的发病率由于肾上腺移植，因为没有手术并发症。1年移植肾和胰腺功能令人满意（估计肾小球滤过率：55 mL/min/1.73 m2，HbA 1c：4.8%）。肾上腺移植物在12个月时功能良好，皮质醇和醛固酮基线水平正常化。3个月时的功能成像显示肾上腺移植物对[123 I]-间碘苄胍的摄取良好。对于等待肾或肾胰联合移植的肾上腺功能不全患者，肾上腺与左肾联合移植似乎是一个很好的治疗选择。
Adrenal insufficiency is a rare but life‐threatening disease. Replacement therapy sometimes fails to prevent an acute adrenal crisis and most often does not lead to restoration of well‐being. We report here the 1‐year outcome of the first simultaneous kidney–adrenal gland–pancreas transplantation in a 33‐year‐old patient with type 1 diabetes and concomitant autoimmune adrenal insufficiency. En bloc left adrenal gland and kidney grafts were anastomosed on the left iliac vessels in normal vascular conditions and the pancreas graft was anastomosed on the right iliac vessels. The immunosuppressive regimen was not modified by the addition of the adrenal gland. We observed no additional morbidity due to the adrenal gland transplantation, as there were no surgical complications. One‐year kidney and pancreas graft functions were satisfactory (estimated glomerular filtration rate: 55 mL/min/1.73 m2 and HbA1c: 4.8%). The adrenal graft functioned well at 12 months with a normalization of cortisol and aldosterone baseline levels. Functional imaging at 3 months showed good uptake of [123I]‐metaiodobenzylguanidine by the adrenal graft. Transplantation of the adrenal gland en bloc with the left kidney appears to be a good therapeutic option in patients with adrenal insufficiency awaiting kidney or kidney–pancreas transplantation.