Cattral M S, Bigam D L, Hemming A W, Carpentier A, Greig P D, Wright E, Cole E, Donat D, Lewis G F
Multiorgan Transplantation Program, The Toronto General Hospital, University Health Network, and the Departments of Surgery and Medicine, University of Toronto, Toronto, Ontario, Canada.
Ann Surg. 2000 Nov;232(5):688-95. doi: 10.1097/00000658-200011000-00011.
To test the hypothesis that pancreas transplantation using the more physiologic method of portal venous-enteric (PE) drainage could be performed without compromising patient and graft outcome, compared with the standard method of systemic venous-bladder (SB) drainage.
Between November 1995 and November 1998, the authors prospectively followed up 20 consecutive patients with SB drainage followed by 20 consecutive patients with PE drainage. All patients underwent simultaneous pancreas-kidney transplantation, and all were immunosuppressed with antilymphocyte serum, cyclosporin, azathioprine, and steroids.
The actuarial patient survival rate at 1 year was 95% in the SB group and 100% in the PE group. Death-censored kidney graft survival was 100% in both groups; pancreas graft survival was 95% in the SB group and 100% in the PE group. The mean initial hospital stay was 15 days for both groups. However, during the first 6 months after transplantation, the SB group required more medical day-unit visits, mostly for treatment of metabolic acidosis and dehydration. The incidence of urinary tract infections was similar in both groups. The incidence of cytomegalovirus infections was significantly less in the PE group. The incidence of acute rejection was 37% in the SB group and 15% in the PE group. Mean serum creatinine levels 6 months after transplantation were significantly lower in the PE group than in the SB group. Glycemic control was excellent in both groups, but fasting serum insulin levels were significantly lower in the PE group.
The PE method of pancreas transplantation can be performed with excellent patient and graft outcomes.
验证与标准的体静脉-膀胱（SB）引流方法相比，采用更符合生理的门静脉-肠道（PE）引流方法进行胰腺移植不会影响患者及移植物预后的这一假设。
1995年11月至1998年11月，作者前瞻性地连续随访了20例接受SB引流的患者，随后又连续随访了20例接受PE引流的患者。所有患者均接受了同期胰肾联合移植，且均使用抗淋巴细胞血清、环孢素、硫唑嘌呤和类固醇进行免疫抑制治疗。
SB组1年实际患者生存率为95%，PE组为100%。两组死亡截尾肾移植物生存率均为100%；SB组胰腺移植物生存率为95%，PE组为100%。两组平均初始住院时间均为15天。然而，在移植后的前6个月，SB组需要更多的医疗日间病房就诊，主要是为了治疗代谢性酸中毒和脱水。两组尿路感染发生率相似。PE组巨细胞病毒感染发生率显著较低。SB组急性排斥反应发生率为37%，PE组为15%。移植后6个月时，PE组平均血清肌酐水平显著低于SB组。两组血糖控制均良好，但PE组空腹血清胰岛素水平显著较低。
胰腺移植的PE方法可取得优异的患者及移植物预后。
