Simultaneous islet-kidney vs pancreas-kidney transplantation in type 1 diabetes mellitus: a 5 year single centre follow-up
Simultaneous islet-kidney vs pancreas-kidney transplantation in type 1 diabetes mellitus: a 5 year single centre follow-up
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DOI：
10.1007/s00125-007-0860-4
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发表时间：
2008-01-01
期刊：
影响因子：
8.2
通讯作者：
Lehmann, R.
中科院分区：
文献类型：
--
作者：
Gerber, P. A.;Pavlicek, V.;Lehmann, R.
目的/假设本研究的目的是比较1型糖尿病患者胰岛肾联合移植（SIK）和胰肾联合移植（SPK）的长期结局--血糖控制、肾功能和手术相关并发症。GFR和并发症的发生率进行了比较之间的13个接受者的SIK和25个接受者的SPK移植在同一机构。平均随访41个月。结果在SIK组中发生了两个主要器官功能不全。在随访期间的任何时间点，与SPK组相比，SIK组的HbA（1c）均无差异（随访期间平均值为6.3% vs 5.9%）。同样，两组之间的肾功能随时间的变化也没有差异。SPK移植后较高的胰岛素依赖率（1年后96% vs 31%，在SIK组）被较高的严重不良事件发生率（40% reparotomies vs 0%，在SIK组）所抵消。结论/解释胰岛移植所实现的内源性胰岛素产生，结合最佳胰岛素治疗，足以维持接近正常的血糖水平。在血糖控制方面，胰岛移植提供了与胰腺移植相当的结果。然而，SPK导致更高的胰岛素依赖率，尽管以更多的手术并发症为代价。这些结果导致了我们机构胰岛移植的新模式，主要目标不是胰岛素依赖性，而是良好的血糖控制和避免严重低血糖。
Aims/hypothesis The aim of this study was to compare the long-term outcomes-in terms of glucose control, renal function and procedure-related complications-of simultaneous islet-kidney (SIK) transplantation with those of simultaneous pancreas-kidney (SPK) transplantation in patients with type 1 diabetes mellitus.Methods HbA(1c), need for insulin, GFR and complication rate were compared between 13 recipients of SIK and 25 recipients of SPK transplants at the same institution. The mean follow-up was 41 months.Results Two primary organ non-functions occurred in the SIK group. HbA(1c) did not differ at any time point during follow-up in the SIK group compared with the SPK group (mean during follow-up 6.3 vs 5.9%). Similarly, kidney function over time was not different between the two groups. A higher rate of insulin independence following SPK transplantation (after 1 year 96 vs 31% in the SIK group) was counterbalanced by a higher rate of serious adverse events (40% relaparotomies vs 0% in the SIK group).Conclusions/interpretation The endogenous insulin production achieved by islet transplantation, combined with optimal insulin therapy, was sufficient for maintaining near-normal glucose levels. In terms of glucose control, islet transplantation provides results comparable to those achieved with pancreas transplantation. However, SPK results in a higher rate of insulin independence, albeit at the cost of more surgical complications. These results have led to a new paradigm in islet transplantation at our institution, where the primary goal is not insulin independence, but good glucose control and avoidance of severe hypoglycaemia.