Present status of pancreas transplantation in Japan-donation predominantly from marginal donors and modified surgical technique: Report of Japan pancreas transplantation registry
Present status of pancreas transplantation in Japan-donation predominantly from marginal donors and modified surgical technique: Report of Japan pancreas transplantation registry
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DOI：
10.1016/j.transproceed.2008.01.047
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发表时间：
2008-03-01
影响因子：
0.9
通讯作者：
Kanazawa, Y.
中科院分区：
文献类型：
--
作者：
Ishibashi, M.;Ito, T.;Kanazawa, Y.
在日本，由于严格的捐赠标准，器官捐赠仍然受到限制。本研究的目的是通过分析即使在较差的供体条件下的结果来显示胰腺移植（PTx）的有效性。本文对近8年来施行的36例PTx（32例胰肾联合移植，4例肾移植后胰腺移植）的供体特点进行了研究。平均供体年龄为41.4 +/- 11.9岁，与美国和欧洲相比年龄大得多;年龄超过40岁的供体占总数的67%。根据Kapur描述的标准，29例（81%）在我们的系列将被认为是边缘。因此，为了增加胰头的血液供应，使用供体动脉将胃十二指肠动脉（GDA）缝合到肝总动脉或髂Y型移植物。这些程序在24例肝切除病例中的16例中进行。最终，34例（94%）保留了GDA连续性。平均总冷缺血时间为12小时1.5分钟。在214名登记者中，17名等待SPK的患者死于糖尿病并发症。迄今为止，患者生存率保持100%，平均随访期为33个月。移植后1、3和5年的胰腺移植物存活率分别为92%、80%和80%。相比之下，肾脏存活率分别为91%、91%和91%。通过保留GDA的连续性，胰头和十二指肠的完整性可能降低了与边缘供体相关的风险。
In Japan, organ donation has been still limited because of the strict donor criteria. The aim of this study was to show the effectiveness of pancreas transplantation (PTx) by analyzing the outcomes even under poor donor conditions. Thirty-six cases of PTx (32 simultaneous pancreas and kidney transplantations [SPK], 4 pancreas after kidney transplantations) performed during the last 8 years were examined especially for donor characteristics. Mean donor age of 41.4 +/- 11.9 years was considerably older compared with that in the United States and Europe; donors aged over 40 years comprised 67% of the total. According to the criteria described by Kapur, 29 cases (81%) in our series would be considered marginal. Thus, to increase blood supply into the pancreatic head, the gastroduodenal artery (GDA) was anastomosed using donor artery to common hepatic artery or iliac Y graft. These procedures were performed in 16 of the 24 cases in which there was liver procurement. Eventually, 34 cases (94%) preserved GDA continuity. Mean total cold ischemic time of pancreatic grafts was 12 hours 1.5 minutes. Of 214 registrants, 17 patients on the waiting list for SPK died of diabetic complications. To date, patient survival remains 100% with a mean follow-up period of 33 months. Pancreas graft survivals at 1, 3, and 5 years posttransplantation were 92%, 80%, and 80%, respectively. In contrast, kidney survivals were 91%, 91%, and 91%, respectively. The integrity of the pancreas head and duodenum by preservation of the GDA continuity might have decreased the risk associated with the marginal donors.