Capocasale Enzo, Busi Nicola, Mazzoni Maria Patrizia, Valle Raffaele Dalla, Maggiore Umberto, Bignardi Lucia, Buzio Carlo, Sianesi Mario
Department of Surgery, General Surgery and Organ Transplantation, University Hospital, Parma, Italy.
Acta Biomed. 2007 Aug;78(2):123-7.
Diabetes mellitus is one of the major causes of end stage renal disease. After 10-15 years from the onset 30% of diabetic patients present nephropathy, and once haemodialysis is required, morbidity is particularly high and long-term survival is lower than in non-diabetic patients. Currently, it is demonstrated that simultaneous pancreas-kidney transplantation (SPK) shows beneficial effects on patient survival, on some diabetic degenerative complications and on the quality of life. Aim of the work is to report our experience in pancreas transplantation.
From June 1998 to June 2005 17 type I diabetic uremic patients underwent SPK. Donor selection considered hemodynamically stable young patients without cardiac arrest or vasopressor drug excess and with a brief Intensive Care Unit hospitalization. Average donor age was 26 years (range 16-38). The cause of death was trauma for 14 donors (82.4%) and spontaneous cerebral hemorrhage for 3 donors (17.6%). Average pancreas cold ischemic time was 716 minutes (range 320-968).
No patient mortality was observed. No primary or delayed graft function was observed both for pancreas and kidney. Biopsy proved the occurrence of acute rejection episode in one patient (5.8%). Five surgical (29.4%) and 2 medical (11.7%) complications developed. At a median follow-up of 36.4 months (range 4.2-88) patient survival rate was 100%. Pancreas and kidney graft survival rate was 76.5% and 94.1%, respectively. All patients referred an improvement in their quality of life.
SPK represents a well-established therapy for uremic type I diabetes mellitus since it improves patient survival in selected recipients. Our experience, as reported in literature, confirm that a successful pancreas transplantation not only brings the recipient back to normal glycemic levels, but it also improves the patient's quality of life by stabilizing some of the secondary complications of diabetes.
糖尿病是终末期肾病的主要病因之一。糖尿病发病10 - 15年后，30%的糖尿病患者会出现肾病，一旦需要进行血液透析，发病率会特别高，且长期生存率低于非糖尿病患者。目前，已证实胰肾联合移植（SPK）对患者生存率、某些糖尿病退行性并发症及生活质量具有有益影响。本研究的目的是报告我们在胰腺移植方面的经验。
1998年6月至2005年6月，17例I型糖尿病尿毒症患者接受了SPK。供体选择考虑血流动力学稳定的年轻患者，无心脏骤停或血管活性药物过量使用情况，且在重症监护病房住院时间较短。供体平均年龄为26岁（范围16 - 38岁）。14例供体（82.4%）的死亡原因是创伤，3例供体（17.6%）的死亡原因是自发性脑出血。胰腺冷缺血时间平均为716分钟（范围320 - 968分钟）。
未观察到患者死亡。胰腺和肾脏均未观察到原发性或延迟性移植物功能障碍。活检证实1例患者（5.8%）发生急性排斥反应。出现了5例外科并发症（29.4%）和2例内科并发症（11.7%）。中位随访36.4个月（范围4.2 - 88个月）时，患者生存率为100%。胰腺和肾脏移植物生存率分别为76.5%和94.1%。所有患者均表示生活质量有所改善。
SPK是治疗I型糖尿病尿毒症的一种成熟疗法，因为它能提高特定受体的患者生存率。正如文献报道的我们的经验所证实的那样，成功的胰腺移植不仅能使受体血糖水平恢复正常，还能通过稳定糖尿病的一些继发性并发症来改善患者的生活质量。
Zotero 插件