Schulz T, Schenker P, Flecken M, Schäffer M, Viebahn R, Kapischke M
Chirurgische Universitätsklinik, Knappschaftskrankenhaus, Ruhr-Universität Bochum.
Zentralbl Chir. 2005 Apr;130(2):132-6. doi: 10.1055/s-2005-836339.
Simultaneous pancreas kidney transplantation (SPK) is an established therapy for type 1 diabetics with end stage or preterminal renal disease. SPK is superior to isolated kidney transplantation (KTX) in diabetic patients. Even pancreas-re-transplantations are more common in these patients now, mostly after SPK. But Experience with SPK after KTX is rare. Between 1994 and 2003 six Re-SPK 4.5 to 8.5 years after KTX were performed in our department. Average age of the recipients was 40.5 years. They had been suffering from diabetes for an average of 29.3 years. Four recipients were on dialysis again, whereas two had preterminal renal insufficiency. Pancreas transplants were drained through the bladder (n = 1) or into the small intestine (n = 5) with systemic venous anastomosis. After a median observation period of 28 months (8 to 99 months) all six recipients are insulin free. One patient lost his kidney graft due to severe acute rejection. Therefore kidney graft survival is 83 %. Four acute rejections (66 %) were observed in 4 patients. Only one rejection was treated successfully by steroids. Two rejections could be stopped with antibodies. 3 patients had infections in the early postoperative period (sinusitis, urinary tract infection, wound infection). Even after KTX with graft failure, diabetic patients suffering from renal disease can be re-transplanted successfully with SPK.
同期胰肾联合移植（SPK）是终末期或终前期肾病1型糖尿病患者的一种成熟治疗方法。在糖尿病患者中，SPK优于单纯肾移植（KTX）。现在这些患者中胰腺再次移植更为常见，大多在SPK之后。但KTX后进行SPK的经验很少。1994年至2003年期间，我们科室对6例在KTX后4.5至8.5年进行再次SPK的患者进行了手术。受者的平均年龄为40.5岁。他们患糖尿病的平均时间为29.3年。4例受者再次接受透析，而2例患有终前期肾功能不全。胰腺移植通过膀胱引流（n = 1）或引流至小肠（n = 5）并进行体静脉吻合。经过中位观察期28个月（8至99个月）后，所有6例受者均无需使用胰岛素。1例患者因严重急性排斥反应失去了肾移植。因此，肾移植存活率为83%。4例患者出现4次急性排斥反应（66%）。只有1次排斥反应通过类固醇治疗成功。2次排斥反应通过抗体得以控制。3例患者在术后早期发生感染（鼻窦炎、尿路感染、伤口感染）。即使在KTX后移植失败，患有肾病的糖尿病患者仍可通过SPK成功进行再次移植。
