Farney A C, Cho E, Schweitzer E J, Dunkin B, Philosophe B, Colonna J, Jacobs S, Jarrell B, Flowers J L, Bartlett S T
Joseph and Corrine Schwartz Division of Transplantation and the Divisions of General Surgery and Urology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
Ann Surg. 2000 Nov;232(5):696-703. doi: 10.1097/00000658-200011000-00012.
To review the authors' experience with a new approach for type I diabetic uremic patients: simultaneous cadaver-donor pancreas and living-donor kidney transplant (SPLK).
Simultaneous cadaver kidney and pancreas transplantation (SPK) and living-donor kidney transplantation alone followed by a solitary cadaver-donor pancreas transplant (PAK) have been the transplant options for type I diabetic uremic patients. SPK pancreas graft survival has historically exceeded that of solitary pancreas transplantation. Recent improvement in solitary pancreas transplant survival rates has narrowed the advantage seen with SPK. PAK, however, requires sequential transplant operations. In contrast to PAK and SPK, SPLK is a single operation that offers the potential benefits of living kidney donation: shorter waiting time, expansion of the organ donor pool, and improved short-term and long-term renal graft function.
Between May 1998 and September 1999, the authors performed 30 SPLK procedures, coordinating the cadaver pancreas transplant with simultaneous transplantation of a laparoscopically removed living-donor kidney. Of the 30 SPLKs, 28 (93%) were portally and enterically drained. During the same period, the authors also performed 19 primary SPK and 17 primary PAK transplants.
One-year pancreas, kidney, and patient survival rates were 88%, 95%, and 95% for SPLK recipients. One-year pancreas graft survival rates in SPK and PAK recipients were 84% and 71%. Of 30 SPLK transplants, 29 (97%) had immediate renal graft function, whereas 79% of SPK kidneys had immediate function. Reoperative rates, early readmission to the hospital, and initial length of stay were similar between SPLK and SPK recipients. SPLK recipients had a shorter wait time for transplantation.
Early pancreas, kidney, and patient survival rates after SPLK are similar to those for SPK. Waiting time was significantly shortened. SPLK recipients had lower rates of delayed renal graft function than SPK recipients. Combining cadaver pancreas transplantation with living-donor kidney transplantation does not harm renal graft outcome. Given the advantages of living-donor kidney transplant, SPLK should be considered for all uremic type I diabetic patients with living donors.
回顾作者对I型糖尿病尿毒症患者采用新方法的经验：同时进行尸体供体胰腺和活体供体肾脏移植（SPLK）。
同时进行尸体肾脏和胰腺移植（SPK）以及单独进行活体供体肾脏移植，随后进行单独的尸体供体胰腺移植（PAK）一直是I型糖尿病尿毒症患者的移植选择。从历史上看，SPK胰腺移植物的存活率超过了单独胰腺移植。近期单独胰腺移植存活率的提高缩小了SPK的优势。然而，PAK需要进行序贯移植手术。与PAK和SPK不同，SPLK是一种单一手术，具有活体肾脏捐赠的潜在益处：等待时间缩短、器官供体库扩大以及短期和长期肾移植功能改善。
1998年5月至1999年9月期间，作者进行了30例SPLK手术，将尸体胰腺移植与腹腔镜切除的活体供体肾脏同时移植相协调。在30例SPLK手术中，28例（93%）采用门静脉和肠道引流。同期，作者还进行了19例初次SPK和17例初次PAK移植。
SPLK受者的1年胰腺、肾脏和患者存活率分别为88%、95%和95%。SPK和PAK受者的1年胰腺移植物存活率分别为84%和71%。在30例SPLK移植中，29例（97%）具有立即肾移植功能，而SPK肾脏的79%具有立即功能。SPLK和SPK受者之间的再次手术率、早期再次入院率和初始住院时间相似。SPLK受者的移植等待时间较短。
SPLK术后早期胰腺、肾脏和患者存活率与SPK相似。等待时间显著缩短。SPLK受者延迟肾移植功能的发生率低于SPK受者。将尸体胰腺移植与活体供体肾脏移植相结合不会损害肾移植结果。鉴于活体供体肾脏移植的优势，对于所有有活体供体的尿毒症I型糖尿病患者都应考虑SPLK。
