Gruessner A C, Sutherland D E
International Pancreas Transplant Registry, Diabetes Institute for Immunology and Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Clin Transpl. 2000:45-72.
As of October 2000, > 15,000 pancreas transplant had been reported to the IPTR, > 11,000 in the US and > 4,000 outside the US. An era analysis of US cases from 1987-2000 showed a progressive improvement in outcome (p < 0.04), with pancreas transplant graft survival rates (GSRs) going from 72% to 82% at one year for SPK cases, from 52% to 74% for PAK cases, and from 47% to 76% for PTA cases. The improvements were due both to decreases in technical failure (TF) rates (overall from 16% to 7%) and immunological failure rates (going from 8% to 2% for SPK, from 27% to 6% for PAK, and from 37% to 12% for PTA cases). The proportion of recipients > 45 years old increased from 5% to 25%, and the improved outcomes encompassed the older patients as well. In patients > 45 years old, SPK pancreas GSRs at one year increased from 62% to 78% (p < 0.002). Pancreas GSRs were also similar for recipients reported to have Type 1 or Type 2 diabetes (at one year, 84% and 83%, respectively for 1996-2000 SPK transplants), the latter designated in 3% of the recipients. Contemporary pancreas transplant outcomes were calculated separately for 1996-2000 US and non-US cases. US patient survival rates at one year were > or = 94% in each recipient category, with one-year pancreas GSRs of 84% for SPK (n = 3,697), 76% for PAK (n = 696), and 71% for PTA (n = 300) (p = 0.0001). The immunological graft failure rates for 1996-2000 US SPK, PAK and PTA cases were 2%, 6%, and 8% at one year (p = 0.001). There was a progressive increase in the use of ED (as opposed to BD) for duct management, to > 50% for 1996-2000 US SPK transplants. Approximately 20% of US SPK ED transplants had venous drainage via the portal system. Pancreas GSRs were not significantly different for 1996-2000 ED (n = 1,940) and BD (n = 1,541) US SPK transplants (83% and 84%, respectively, at one year), nor was there a difference in pancreas GSRs for systemic (n = 1,509) versus portal (n = 411) venous drained ED SPK transplants (83% for both at one year). Kidney GSRs were also not significantly different for ED versus BD US SPK cases, 93% versus 91% at one year (p = 0.13). Duct management did matter for solitary (PAK and PTA) pancreas transplants (P < or = 0.07). Pancreas GSRs for PAK recipients were 77% at one year for BD (n = 359) versus 67% for ED (n = 306) US transplants; for PTA 75% (n = 174) versus 63%. However, BD transplants were associated with a 12% conversion rate to ED by 2 years after transplantation. Analyses of outcome by immunosuppression for US cases showed pancreas GSRs ranged from 77% to 88% at one year, but were highest in SPK recipients given anti-T-cell agents for induction and CSA-MMF for maintenance immunosuppression. For PAK and PTA recipients, those given anti-T-cell agents for induction and TAC-MMF for maintenance immunosuppression had the highest GSRs: 78% and 78%, respectively, at one year for BD pancreas transplants (vs. 85% in BD SPK recipients similarly immunosuppressed, P > 0.08). In regard to non-US cases, the overwhelming majority were in the SPK category (n = 676 for 1996-2000), with a one-year pancreas GSR of 84%, not significantly different than for US cases. In summary, pancreas transplant graft survival rates were > 70% in the solitary (PAK and PTA) and > 80% in SPK recipients during the last 4 years of the 20th century. These outcomes culminate a third of a century of application for the treatment of diabetes mellitus.
截至2000年10月，国际胰腺移植登记处（IPTR）报告的胰腺移植病例已超过15,000例，其中美国有11,000多例，美国以外有4,000多例。对1987 - 2000年美国病例的年代分析显示，治疗效果有逐步改善（p < 0.04），胰肾联合移植（SPK）病例的胰腺移植移植物存活率（GSR）在1年时从72%提高到82%，胰腺移植后肾移植（PAK）病例从52%提高到74%，胰腺移植单独移植（PTA）病例从47%提高到76%。这些改善归因于技术失败（TF）率的降低（总体从16%降至7%）和免疫失败率的降低（SPK从8%降至2%，PAK从27%降至6%，PTA从37%降至12%）。45岁以上受者的比例从5%增加到25%，改善的效果也涵盖了老年患者。在45岁以上的患者中，SPK胰腺1年GSR从62%提高到78%（p < 0.002）。据报告患有1型或2型糖尿病的受者的胰腺GSR也相似（在1996 - 2000年的SPK移植中，1年时分别为84%和83%），后者占受者的3%。分别计算了1996 - 2000年美国和非美国病例的当代胰腺移植结果。美国各受者类别1年时的患者存活率≥94%，SPK的1年胰腺GSR为84%（n = 3,697），PAK为76%（n = 696），PTA为71%（n = 300）（p = 0.0001）。1996 - 2000年美国SPK、PAK和PTA病例1年时的免疫移植物失败率分别为2%、6%和8%（p = 0.001）。在导管管理方面，急诊手术（ED，相对于传统手术BD）的使用逐渐增加，在1996 - 2000年美国SPK移植中超过50%。美国约20%的SPK急诊手术移植通过门静脉系统进行静脉引流。1996 - 2000年美国SPK急诊手术（n = 1,940）和传统手术（n = 1,541）移植的胰腺GSR无显著差异（1年时分别为83%和84%），经全身静脉引流（n = 1,509）与经门静脉引流（n = 411）的急诊手术SPK移植的胰腺GSR也无差异（1年时均为83%）。美国SPK急诊手术与传统手术病例的肾GSR也无显著差异，1年时分别为93%和91%（p = 0.13）。导管管理对单独胰腺移植（PAK和PTA）很重要（P≤0.07）。PAK受者传统手术移植1年时的胰腺GSR为77%（n = 359），美国急诊手术移植为67%（n = 306）；PTA分别为75%（n = 174）和63%。然而，传统手术移植在移植后2年内有12%转换为急诊手术。对美国病例按免疫抑制进行的治疗效果分析显示，1年时胰腺GSR在77%至88%之间，但在接受抗T细胞药物诱导和环孢素A - 霉酚酸酯（CSA - MMF）维持免疫抑制的SPK受者中最高。对于PAK和PTA受者，接受抗T细胞药物诱导和他克莫司 - 霉酚酸酯（TAC - MMF）维持免疫抑制的GSR最高：传统手术胰腺移植1年时分别为78%和78%（与同样免疫抑制的传统手术SPK受者中的85%相比，P>0.08）。关于非美国病例，绝大多数属于SPK类别（1996 - 2000年为n = 676），1年胰腺GSR为84%，与美国病例无显著差异。总之，在20世纪的最后4年中，单独胰腺移植（PAK和PTA）的胰腺移植移植物存活率>70%，SPK受者>80%。这些成果代表了长达三分之一世纪的糖尿病治疗应用成果。
