Orsenigo E, Socci C, Fiorina P, Zuber V, Secchi A, Di Carlo V, Staudacher C
Department of Surgery, Vita e Salute University, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
Transplant Proc. 2005 Oct;37(8):3570-1. doi: 10.1016/j.transproceed.2005.09.059.
The aim of our study was to demonstrate the cardiovascular benefits of simultaneous pancreas-kidney transplantation when compared to kidney-alone transplants in diabetic recipients.
A total of 386 renal transplants were performed from 1985 to 2004, including 262 (68%) in diabetic recipients and 124 (32%) in nondiabetics. Among the former group, 200 kidneys were transplanted simultaneously to the pancreatic graft (KP group) and 62 were kidney-alone transplants (KA group). The mean time on dialysis was 31 +/- 20 months (range 0-126 months). The duration of diabetes was 24 +/- 7 years (range 5-51 years). Ninety-nine percent of the patients were on renal replacement therapy (79% on hemodialysis and 20% on peritoneal dialysis).
Among 262 patients, 28 (11%) died due to a cardiovascular event, which was higher among KA patients compared with the KP group (P = .004). Overall patient survival was significantly higher in the KP group when compared with the KA group (log-rank: P = .0004). Patient survivals were 80% and 70% versus 70% and 40% at 5 and 10 years in the KP and KA groups, respectively. Kidney graft survivals were 81% and 60% versus 63% and 26% at 5 and 10 years in the KP and KA groups, respectively. Pancreas graft survival was 70% and 50% at 5 and 10 years, respectively.
This clinical evaluation, even if retrospective, confirmed that simultaneous pancreas-kidney transplantation has a protective effect against cardiovascular mortality in diabetic recipients affected by end-stage renal disease.
我们研究的目的是证明与仅接受肾脏移植的糖尿病受者相比，同期胰肾联合移植对心血管的益处。
1985年至2004年共进行了386例肾移植，其中糖尿病受者262例（68%），非糖尿病受者124例（32%）。在前一组中，200例肾脏与胰腺移植物同期移植（KP组），62例为单纯肾脏移植（KA组）。透析平均时间为31±20个月（范围0 - 126个月）。糖尿病病程为24±7年（范围5 - 51年）。99%的患者接受肾脏替代治疗（79%接受血液透析，20%接受腹膜透析）。
262例患者中，28例（11%）死于心血管事件，KA组患者的这一比例高于KP组（P = .004）。与KA组相比，KP组的总体患者生存率显著更高（对数秩检验：P = .0004）。KP组和KA组在5年和10年时的患者生存率分别为80%和70%以及70%和40%。KP组和KA组在5年和10年时的肾移植生存率分别为81%和60%以及63%和26%。胰腺移植在5年和10年时的生存率分别为70%和50%。
这项临床评估，即使是回顾性的，也证实了同期胰肾联合移植对终末期肾病糖尿病受者的心血管死亡率有保护作用。
