Zieliński Adam, Nazarewski Sławomir, Bogetti Diego, Sileri Pierpaolo, Testa Giuliano, Sankary Howard, Benedetti Enrico
Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA.
Transplantation. 2003 Aug 15;76(3):547-52. doi: 10.1097/01.TP.0000076624.79720.14.
Simultaneous pancreas and kidney transplantation (SPK) from cadaveric donors has become a widely accepted therapeutic option for insulin-dependent uremic patients. In 1996 the first SPK from a live donor was performed. This procedure offers the advantage of a better immunologic match, reduced cold ischemia injury, and decreased waiting time. As such, it is an attractive alternative treatment for diabetic patients with end-stage nephropathy with an available living donor.
We performed six SPKs from living-related donors. There were four men and two women among the recipients; median age was 34 (range, 29-39) years. All donors were recipients' siblings with excellent HLA matching. Donors underwent standardized metabolic workup, anti-insulin and anti-islet antibody assays, and computed tomography of the abdomen. Both donors and recipients were treated with octreotide for 5 days perioperatively. After transplantation, the patients were maintained on tacrolimus-based immunosuppression, with the exception of one recipient of SPK from an identical twin, who received cyclosporine monotherapy.
All the donors are doing well and have normal renal function and blood glucose levels. One-year patient, renal, and pancreatic graft survival rates were 100%, 100%, and 83%, respectively. Acute kidney rejection was documented in two patients, and both recovered completely after OKT3 therapy. No rejection of pancreatic graft has been documented. Except for one patient who lost the graft because of hemorrhagic pancreatitis, all recipients maintained serum glucose levels at less than 130 mg/dL without insulin therapy. No major surgical complications such as graft thrombosis, intra-abdominal infection, or abscess were reported.
Living donor SPK can represent a successful alternative to cadaveric donor SPK. The procedure can be performed safely in the donor and with low morbidity in the recipient.
尸体供体的胰肾联合移植（SPK）已成为胰岛素依赖型尿毒症患者广泛接受的治疗选择。1996年进行了首例活体供体SPK。该手术具有免疫匹配更好、冷缺血损伤减轻和等待时间缩短的优点。因此，对于有合适活体供体的终末期肾病糖尿病患者，它是一种有吸引力的替代治疗方法。
我们进行了6例亲属活体供体的SPK。受者中有4名男性和2名女性；中位年龄为34岁（范围29 - 39岁）。所有供体均为受者的兄弟姐妹，HLA匹配良好。供体接受了标准化的代谢检查、抗胰岛素和抗胰岛抗体检测以及腹部计算机断层扫描。供体和受者在围手术期均接受奥曲肽治疗5天。移植后，除1例同卵双胞胎供体的SPK受者接受环孢素单药治疗外，其余患者均接受以他克莫司为基础的免疫抑制治疗。
所有供体情况良好，肾功能和血糖水平正常。1年时患者、肾和胰腺移植物存活率分别为100%、100%和83%。2例患者出现急性肾排斥反应，经OKT3治疗后均完全恢复。未记录到胰腺移植物排斥反应。除1例因出血性胰腺炎失去移植物的患者外，所有受者在未接受胰岛素治疗的情况下血清葡萄糖水平维持在130 mg/dL以下。未报告重大手术并发症，如移植物血栓形成、腹腔内感染或脓肿。
活体供体SPK可成为尸体供体SPK的成功替代方法。该手术在供体中可安全进行，在受者中发病率较低。
