Kornberg Arno, Küpper Bernadett, Bärthel Erik, Tannapfel Andrea, Müller Ulrich A, Thrum Katharina, Kloos Christof, Wolf Gunter
Department of General, Visceral and Vascular Surgery, Friedrich-Schiller-University, Jena, Germany.
Transplantation. 2009 Feb 27;87(4):542-5. doi: 10.1097/TP.0b013e3181949cce.
We report about our experience with combined en-bloc liver-pancreas transplantation in 14 patients with liver cirrhosis and insulin dependent type 2 diabetes mellitus. Exocrine drainage was achieved by duodeno-duodenostomy. Median posttransplant follow-up is currently 92.5 months. All patients were rendered independent from insulin therapy shortly after transplantation. Levels of glycosylated hemoglobin normalized in all recipients. Mean fasting C-peptide values increased from pretransplant 7.0+/-1.7 ng/mL to 10.5+/-2.9 ng/mL 3 months posttransplantation (P<0.001). One recipient (7.1%) developed recurrent exogenous insulin dependence 7 years after transplantation. Pancreas allograft rejection was confirmed by endoscopic biopsy of donor duodenum mucosa in two patients (14.3%). Calculated 5- and 7-year survival is currently at 64.3% and 64.3%, respectively. Our results indicate that combined en-bloc liver-pancreas transplantation using duodeno-duodenostomy is technically feasible and leads to excellent long-term control of glucose metabolism in patients with liver cirrhosis and insulin-dependent type 2 diabetes.
我们报告了14例肝硬化合并胰岛素依赖型2型糖尿病患者接受整块肝胰联合移植的经验。通过十二指肠-十二指肠吻合术实现外分泌引流。目前移植后的中位随访时间为92.5个月。所有患者在移植后不久即不再依赖胰岛素治疗。所有受者的糖化血红蛋白水平均恢复正常。移植后3个月，空腹C肽平均水平从移植前的7.0±1.7 ng/mL升至10.5±2.9 ng/mL（P<0.001）。1例受者（7.1%）在移植后7年出现复发性外源性胰岛素依赖。通过对2例患者（14.3%）供体十二指肠黏膜进行内镜活检确诊胰腺移植排斥反应。目前计算得出的5年和7年生存率分别为64.3%和64.3%。我们的结果表明，采用十二指肠-十二指肠吻合术的整块肝胰联合移植在技术上是可行的，并且能使肝硬化合并胰岛素依赖型2型糖尿病患者的血糖代谢得到良好的长期控制。
