Drognitz O, Hopt U T
Klinik und Poliklinik für Chirurgie, Abteilung für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg.
Zentralbl Chir. 2003 Oct;128(10):821-30. doi: 10.1055/s-2003-44336.
Since its introduction in 1966, pancreas transplantation has undergone considerable progress. Refinements in surgical technique, better organ preservation solutions, and more potent immunosuppressive therapies have improved patient and graft-survival rates dramatically. Survival rates for patient and pancreas at 1 year approach 95 and 83 %, resp., for simultaneous pancreas and kidney transplantation, and 97 and 78 %, resp., for pancreas alone. US pancreas graft and patient survival rates do not significantly differ from the results of the European centers. However, there is still a hesitant acceptance of combined pancreas-kidney transplantation in Germany. Combined pancreas-kidney transplantation is nowadays the treatment of choice in carefully selected patients with type 1 insulin-dependent diabetes mellitus and end-stage renal failure. Many US centers even advocate combined transplantation in diabetic patients at a pre-uremic stage. Pancreas transplantation significantly improves quality of life and provides excellent long-term glycemic control which halts or even ameliorates secondary diabetic complications such as microangiopathy and neuropathy. In addition, there is increasing evidence that successful pancreas transplantation significantly prolongs patient survival mainly by a reduction of cardiovascular-related mortality. Current 10-year patient survival rate after SPK exceeds 70 %. For diabetics with end-stage renal disease there is no alternative treatment available with comparable live expectancy. However, morbidity and mortality after SPK is still higher than for kidney transplantation alone in the first year. Outcome of isolated pancreas transplantation is also improving but this technique is still restricted to non-uremic patients with severe diabetic complications or with brittle diabetes and severe impairment of quality of life.
自1966年引入以来，胰腺移植取得了长足的进展。手术技术的改进、更好的器官保存溶液以及更强效的免疫抑制疗法显著提高了患者和移植物的存活率。对于同时进行胰腺和肾脏移植的患者，1年时患者和胰腺的存活率分别接近95%和83%；对于单独进行胰腺移植的患者，这两个比例分别为97%和78%。美国胰腺移植物和患者的存活率与欧洲中心的结果没有显著差异。然而，在德国，胰腺-肾脏联合移植的接受度仍然不高。如今，胰腺-肾脏联合移植是精心挑选的1型胰岛素依赖型糖尿病合并终末期肾衰竭患者的首选治疗方法。许多美国中心甚至主张在糖尿病患者处于尿毒症前期时进行联合移植。胰腺移植显著提高了生活质量，并提供了出色的长期血糖控制，可阻止甚至改善糖尿病的继发性并发症，如微血管病变和神经病变。此外，越来越多的证据表明，成功的胰腺移植主要通过降低心血管相关死亡率显著延长患者的生存期。目前，胰肾联合移植术后10年患者存活率超过70%。对于终末期肾病的糖尿病患者，没有其他可提供类似预期寿命的替代治疗方法。然而，胰肾联合移植术后第一年的发病率和死亡率仍高于单纯肾脏移植。单纯胰腺移植的结果也在改善，但该技术仍仅限于患有严重糖尿病并发症或脆性糖尿病且生活质量严重受损的非尿毒症患者。
