Pancreas transplantation. An initial experience with systemic and portal drainage of pancreatic allografts.
Pancreas transplantation. An initial experience with systemic and portal drainage of pancreatic allografts.
复制标题
DOI：
10.1097/00000658-199206000-00005
复制
发表时间：
1992-06
影响因子：
9
通讯作者：
L. Rosenlof;R. C. Earnhardt;T. L. Pruett;William C. Stevenson;Mary T. Douglas;G. Cornett;J. Hanks
中科院分区：
文献类型：
--
作者：
L. Rosenlof;R. C. Earnhardt;T. L. Pruett;William C. Stevenson;Mary T. Douglas;G. Cornett;J. Hanks
胰腺移植自1966年问世以来，已经发生了巨大的变化。随着新的移植中心的发展，胰腺移植相关并发症的评估导致了外科技术的进步。此外，移植导致的胰腺手术改变（胰岛素的全身释放和去神经支配）对葡萄糖代谢的影响尚未得到证实。自1988年以来，作者在20例年龄为18 - 49岁的患者中进行了21例移植（16例胰腺/肾脏联合移植，3例单独胰腺移植，其中包括1例再次移植，1例既往肾移植后胰腺移植，以及1例“集群”移植）;平均年龄为35 ± 1岁。患者总生存率为95%。三个胰腺移植失败的第一年内，因为技术故障;一个额外的胰腺失去了免疫事件术后第449天，胰腺移植的总生存率为81%。无移植肾丢失。为了评估移植失败的原因，比较了人口统计学数据，包括供体和受体的年龄和性别，手术时间，术中输血和移植物缺血时间。除缺血时间（技术成功组为11.7 +/- 6.4小时，技术失败组为19.8 +/- 3.7小时;非配对Student t检验p <0.05）外，两组间无统计学显著差异。使用了四联免疫抑制剂，包括泼尼松、环孢素、硫唑嘌呤和抗淋巴母细胞球蛋白。每例患者平均发生1.2次（范围，0至3次）排斥反应。平均住院时间为24 +/- 11天。通过比较技术成功（TS）组（n = 17）与技术失败（TF）组，评价手术和感染并发症。TS组的手术并发症平均为1.3次/例，而TF组为3.7次/例。与TF相比，TS的感染并发症发生率也降低（每例患者1.7 vs 4.3次）。巨细胞病毒在两组中均很常见，共发生11次感染，平均术后38天发生。平均术后HbA 1C水平从11 +/-3%降至5 +/- 1%。作者开发了一种新的技术，在三个受体中结合了胰腺静脉流出物的门静脉引流。术前代谢研究显示，所有患者的平均空腹血糖为211 +/- 27 mg/dL，平均刺激血糖值为434 +/- 41 mg/dL;平均空腹胰岛素为23 +/- 4 microU/mL。（400字处截断摘要）
Pancreas transplantation has evolved dramatically since its introduction in 1966. As new centers for transplantation have developed, the evaluation of complications associated with pancreas transplantation has led to advances in surgical technique. Furthermore, surgical alterations of the pancreas resulting from transplantation (systemic release of insulin and denervation) are of unproven consequence on glucose metabolism. Since 1988, the authors have performed 21 transplants (16 combined pancreas/kidney, 3 pancreas alone, which includes 1 retransplantation, 1 pancreas after previous kidney transplant, and 1 "cluster") in 20 patients aged 18 to 49 years; mean, 35 +/- 1 years. Overall patient survival is 95%. Three pancreatic grafts failed within the first year because of technical failure; one additional pancreas was lost to an immunologic event on postoperative day 449, for an overall pancreatic graft survival of 81%. No renal grafts were lost. To evaluate causes of graft failure, demographic data were compared, which included age and sex of the donor and the recipient, operative time, intraoperative blood transfusion, and ischemic time of the graft. No statistically significant differences were found between groups except for ischemic time (11.7 +/- 6.4 hours for the technical success group versus 19.8 +/- 3.7 hours for the technical failure group; p less than 0.05 by unpaired Student's t test). Quadruple immunosuppression was used, which included prednisone, cyclosporine, azathioprine, and antilymphoblast globulin. A mean of 1.2 (range, 0 to 3) rejection episodes per patient occurred. Mean hospital stay was 24 +/- 11 days. Surgical and infectious complications were evaluated by comparing the technical success (TS) group (n = 17) with the technical failure (TF) group. Surgical complications in the TS group revealed a mean of 1.3 episodes per patient, whereas the TF group had 3.7 episodes per patient. The TS also had a reduced incidence of infectious complications compared with the TF (1.7 versus 4.3 episodes per patient). Cytomegalovirus was common in both groups, accounting for 11 infectious episodes, and occurred on a mean postoperative day of 38. Mean postoperative HbA1C levels dropped to 5 +/- 1% from 11 +/- 3%. The authors developed a new technique that incorporates portal drainage of the pancreatic venous effluent in three recipients. Preoperative metabolic studies disclosed a mean fasting glucose of 211 +/- 27 mg/dL and a mean stimulated glucose value of 434 +/- 41 mg/dL for all patients; the mean fasting insulin was 23 +/- 4 microU/mL.(ABSTRACT TRUNCATED AT 400 WORDS)