Mazur Marek J, Rea David J, Griffin Matthew D, Larson Timothy S, Prieto Mikel, Gloor James M, Schwab Thomas R, Textor Stephen C, Nyberg Scott L, Stegall Mark D
Department of Internal Medicine, Division of Nephrology, Mayo Clinic, Rochester, MN 55905, USA.
Transplantation. 2004 Mar 27;77(6):844-9. doi: 10.1097/01.tp.0000114607.62534.c9.
Pancreas transplant alone (PTA) has become accepted therapy for select nonuremic patients with type 1 diabetes mellitus. However, PTA may lead to significant complications including a decline in native renal function. This study examines trends in native renal function during the first posttransplant year in PTA recipients with a spectrum of pretransplant glomerular filtration rates (GFR).
Renal function was studied in 23 recipients of bladder-drained PTA who underwent transplantation from April 1998 through September 2001. GFR was measured by corrected iothalamate clearance at the time of transplant evaluation and 1 year posttransplant and also calculated using the Cockcroft-Gault method at the transplant evaluation; at the day of transplantation; and at 1, 6, and 12 months posttransplant.
Iothalamate clearance decreased in the first year in 96% of patients (22 of 23). The mean measured GFR decreased from 84 +/- 33 mL/min/1.73 m2 pretransplant to 52 +/- 26 mL/min/1.73 m2 at 1 year (P <0.001). Calculated creatinine clearance declined in the majority of patients at both 1 and 12 months after PTA, but some patients, including a few with low GFR, maintained stable renal function. Calculated GFR generally correlated well with measured GFR in most patients, with a few notable exceptions. One patient (baseline GFR, 42 mL/min/1.73 m2) developed renal failure in the first year after transplant and required kidney transplantation.
Bladder-drained PTA results in a decline in native renal function in the majority of patients regardless of the pretransplant GFR. These data suggest the need for strategies to prevent or minimize the decline in renal function after PTA.
单纯胰腺移植（PTA）已成为特定1型糖尿病非尿毒症患者可接受的治疗方法。然而，PTA可能导致严重并发症，包括自身肾功能下降。本研究调查了具有一系列移植前肾小球滤过率（GFR）的PTA受者移植后第一年自身肾功能的变化趋势。
对1998年4月至2001年9月间接受膀胱引流式PTA移植的23例受者的肾功能进行研究。在移植评估时和移植后1年通过校正碘他拉酸盐清除率测量GFR，并在移植评估时、移植日以及移植后1、6和12个月使用Cockcroft-Gault方法计算GFR。
96%的患者（23例中的22例）在第一年碘他拉酸盐清除率下降。测量的平均GFR从移植前的84±33 mL/min/1.73 m²降至1年时的52±26 mL/min/1.73 m²（P<0.001）。大多数患者在PTA后1个月和12个月时计算的肌酐清除率下降，但一些患者，包括少数GFR较低的患者，肾功能保持稳定。在大多数患者中，计算的GFR与测量的GFR总体相关性良好，但有一些明显的例外。1例患者（基线GFR为42 mL/min/1.73 m²）在移植后第一年发生肾衰竭，需要进行肾脏移植。
无论移植前GFR如何，膀胱引流式PTA导致大多数患者自身肾功能下降。这些数据表明需要采取策略来预防或尽量减少PTA后肾功能的下降。
