Bladder vs enteric drainage in simultaneous pancreas-kidney transplantation
Bladder vs enteric drainage in simultaneous pancreas-kidney transplantation
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DOI：
10.1093/ndt/gfi252
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发表时间：
2006-02-01
影响因子：
6.1
通讯作者：
McLaughlin, K
中科院分区：
文献类型：
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作者：
Monroy-Cuadros, M;Salazar, A;McLaughlin, K
背景。作为1型糖尿病（IDDM）和继发性糖尿病肾病患者的有效治疗选择，胰肾同步移植（SPK）由于手术技术，特别是胰腺外分泌模式的限制，比其他实体器官移植还不够成熟。由于膀胱引流（BD）的长期并发症，肠引流（ED）最近越来越受欢迎。 目的。自我们开始尝试此类移植以来，比较了肠内引流与膀胱外分泌引流 SPK 移植的结果。方法。自1998年3月至2004年10月，共进行了53例SPK移植，其中膀胱引流（BD）30例，肠引流（ED）23例。诱导治疗包括抗淋巴细胞球蛋白（ALG）或抗CD25单克隆抗体。维持方案包括他克莫司 (TAC)/环孢素 (CsA)、吗替麦考酚酯 (MMF) 和类固醇。结果。两组接受者的平均年龄均为 39 +/- 7 岁。两组均未发生吻合口瘘。两组之间的手术并发症没有显着差异。急性排斥反应、主要感染和巨细胞病毒疾病的发生率也相似。然而，BD 组的特点是泌尿系统并发症、代谢性酸中毒和脱水的数量略有增加。初次住院时间也相似。所有具有功能性移植物的患者不再需要外源性胰岛素。 BD 精算患者生存率和移植物三年生存率分别为 96% 和 86%。对于 ED，相应的结果分别为 97% 和 91%。结论。与 BD 相比，ED 不会增加围手术期发病率，并且 ED 与长期胰腺移植失败的增加无关。这些数据表明 ED 优于 BD，应被视为同步胰肾移植的首选技术。
Background. As a valid therapeutic option for patients with type 1 diabetes mellitus (IDDM) and secondary diabetic nephropathy, simultaneous pancreas-kidney (SPK) transplantation remains more undeveloped than other solid organ transplantations due to restrictions of surgical techniques, especially modes of exocrine pancreatic secretion. Enteric drainage (ED) has recently been increasingly popular due to the long-term complications with bladder drainage (BD).Objectives. Compare results of SPK transplants with enteric vs bladder exocrine drainage since the beginning of our experience with this type of transplantation.Methods. From March 1998 to October 2004, 53 SPK transplants were performed, consisting of 30 with bladder drainage (BD) and 23 with enteric drainage (ED). Induction therapy included antilymphocyte globulin (ALG) or anti-CD25 monoclonal antibody. Maintenance regimen consisted of tacrolimus (TAC)/cyclosporine (CsA), mycophenolate mofetil (MMF) and steroids.Results. Mean age of recipients was 39 +/- 7 in both groups. No anastomosis leakage occurred in either group. Surgical complications were not significantly different between the two groups. Incidence of acute rejection, major infections and cytomegalovirus disease were also similar. However, the BD group was characterized by a slight increase in number of urologic complications, metabolic acidosis and dehydration. The length of initial hospital stay was likewise comparable. All patients with a functional graft no longer required exogenous insulin. BD actuarial patient survival and graft three-year survival were 96 and 86%, respectively. For ED, the respective results were 97 and 91%, respectively.Conclusion. Compared with BD, perioperative morbidity is not increased by ED, and ED is not associated with increased long-term pancreas graft failure. These data suggest that ED is superior to BD and should be considered as the preferred technique for simultaneous pancreas-kidney transplants.