Sugitani A, Tanaka M, Takahara S, Uchida K, Yoshimura N, Takahashi K, Toma H, Oshima S, Sonoda T
Department of Surgery and Oncology, Kyushu University School of Medicine, Maidashi, Fukuoka, Japan.
Transplant Proc. 2005 May;37(4):1767-8. doi: 10.1016/j.transproceed.2005.02.070.
In Japan, the number of kidney transplants for the patients with diabetic nephropathy is limited because of an extreme organ shortage and poor patient and graft survival rates. We analyzed the 5-year outcomes in kidney transplant recipients treated with tacrolimus with (group 1; n = 53) and without a diagnosis of diabetic nephropathy (group 2; n = 1432). We also investigated outcomes in patients who received simultaneous pancreas and kidney transplants since 2000 (group 3; n = 15). Patients in group 1 were older than those in group 2, with a shorter duration of pretransplant dialysis (P = .0001). Five-year patient survival rates in groups 1 and 2 were 89.7% and 97.9%, respectively (P = .13), and 5-year graft survival rates were 89.6% and 94.8%, respectively (P = .44). The incidence of acute rejection within 3 months of transplantation was 28.3% in group 1 and 29.2% in group 2 (P = .98). Tacrolimus-based induction therapy was used in 13 of the 15 group 3 cases. Both kidney and pancreas grafts are surviving to date in all but one of the group 3 patients; one patient had the pancreas removed due to venous thrombosis at 7 days. It was concluded that tacrolimus-based therapy resulted in excellent 5-year outcomes in patients who had kidney transplantation because of diabetic nephropathy, despite the higher risks associated with this condition. Tacrolimus was also beneficial in association with simultaneous pancreas and kidney transplantation. These data encourage us to perform kidney transplantation in patients with diabetic nephropathy.
在日本，由于器官极度短缺以及患者和移植物存活率较低，糖尿病肾病患者的肾移植数量有限。我们分析了接受他克莫司治疗的肾移植受者的5年结局，其中有糖尿病肾病诊断的患者为第1组（n = 53），无糖尿病肾病诊断的患者为第2组（n = 1432）。我们还调查了自2000年以来接受同期胰肾联合移植患者的结局（第3组；n = 15）。第1组患者比第2组患者年龄更大，移植前透析时间更短（P = .0001）。第1组和第2组的5年患者生存率分别为89.7%和97.9%（P = .13），5年移植物生存率分别为89.6%和94.8%（P = .44）。移植后3个月内急性排斥反应的发生率在第1组为28.3%，在第2组为29.2%（P = .98）。第3组的15例患者中有13例使用了基于他克莫司的诱导治疗。除1例患者外，第3组所有患者的肾和胰移植物至今均存活；1例患者在术后7天因静脉血栓形成而切除了胰腺。得出的结论是，尽管糖尿病肾病患者存在较高风险，但基于他克莫司的治疗在因糖尿病肾病接受肾移植的患者中产生了良好的5年结局。他克莫司在同期胰肾联合移植中也有益处。这些数据鼓励我们对糖尿病肾病患者进行肾移植。
