Tang Yong, Li You Ping, Li Jian Shui, Zhang Zhao Da, Han Fang Hai, Hu Wei Ming, Tian Bo Le
Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Transplantation. 2007 Sep 15;84(5):629-33. doi: 10.1097/01.tp.0000278179.78975.b1.
The immunological benefits of portal venous drainage (PVD) in pancreas transplantation remain debated clinically. We established simultaneous pancreas-kidney transplantation (SPK) models with portal venous drainage and systemic venous drainage to compare the impact of venous drainage site on acute rejection in pig.
Forty-eight nonrelated, first hybrid landrace pigs were divided into PE (portal-enteric drainage) and SE (systemic-enteric drainage) groups. Type I diabetes mellitus was induced by whole pancreatectomy, and right-side nephrectomy was also performed in the recipients. The donor portal vein was anastomosed to superior mesenteric vein of the recipients in PE group or to the inferior hepatic cava vena of the recipients in SE group. Graft tissue specimens were obtained with laparotomy on Day 3 and 7 after transplant, and the severity of acute rejection was scored according to Nakhleh and Banff criteria.
The cold ischemia time, fasting plasma glucose and urine creatinine of the 2 groups had no statistic difference between 2 groups at Day 1, 3, 5, and 7 after transplant (P>0.05). The occurrence of both pancreas and kidney acute rejections in PE group was significant later and slighter than SE group (P<0.05).
PVD, compared with SVD, could ameliorate and delay acute rejection in pig SPK. It might become a tolerance inducing method of pancreas transplantation, decrease the cost and improve the quality of SPK, if further confirmed by clinical trials.
胰腺移植中门静脉引流（PVD）的免疫益处临床上仍存在争议。我们建立了门静脉引流和体静脉引流的同期胰肾联合移植（SPK）模型，以比较静脉引流部位对猪急性排斥反应的影响。
48只无关的第一代杂种长白猪被分为PE（门静脉-肠道引流）组和SE（体静脉-肠道引流）组。通过全胰切除术诱导I型糖尿病，受体也进行右侧肾切除术。在PE组中，供体门静脉与受体的肠系膜上静脉吻合，在SE组中，供体门静脉与受体的肝下腔静脉吻合。在移植后第3天和第7天通过剖腹术获取移植组织标本，并根据Nakhleh和Banff标准对急性排斥反应的严重程度进行评分。
两组在移植后第1、3、5和7天的冷缺血时间、空腹血糖和尿肌酐无统计学差异（P>0.05）。PE组胰腺和肾脏急性排斥反应的发生均明显晚于且轻于SE组（P<0.05）。
与体静脉引流相比，门静脉引流可改善和延迟猪SPK中的急性排斥反应。如果通过临床试验进一步证实，它可能成为一种诱导胰腺移植耐受的方法，降低成本并提高SPK的质量。
