Woeste G, Moench C, Hauser I A, Geiger H, Scheuermann E, Bechstein W O
Department of General and Visceral Surgery, Goethe-University, Frankfurt, Germany.
Transplant Proc. 2010 Dec;42(10):4202-5. doi: 10.1016/j.transproceed.2010.09.021.
Ischemia-reperfusion injury (IRI) is common after pancreas transplantation, leading to pancreatitis or thrombosis with the need for relaparotomy or even graft loss. Optimal donor selection may reduce the postoperative morbidity of IRI. The Eurotransplant preprocurement pancreas suitability score (P-PASS) seeks to identify ideal donors with a value <17. Owing to the organ shortage the waiting time for pancreas transplantation is increasing, a problem that may be addressed with the use of extended-criteria donors. We analyzed our pancreas transplantations regarding postoperative complications according to the P-PASS. To reflect IRI we used the peak C-reactive protein (CRP) levels during the first 3 postoperative days.
From January 2009 to July 2010, we transplanted 52 pancreas grafts, including, 50 simultaneous pancreas-kidney transplantations (SPK), 1 after a kidney graft, and 1 alone. For 3 SPK donors the P-PASS was not available. All transplantations were performed using systemic venous and enteric drainage. The immunosuppression protocol included antibody induction with antithymocyte globulin and maintenance therapy with steroids, tacrolimus, and mycophenolate mofetil. The peak CRP in the first 3 postoperative days was used as a marker for IRI.
The mean P-PASS of our donors was 16.4 ± 2.6 (range, 12-22). We compared 24 patients receiving organs from "ideal" donors (P-PASS <17; ID) with 25 receiving grafts from extended-criteria donors (P-PASS ≥17; ED). There was no significant difference in the incidence of graft loss among ID versus ED grafts (20.8% vs 20.0%; P = 1.0). Comparing the rates of postoperative complications of patients, we did not observe a significant difference in graft thrombosis (4.2% vs 16.0%; P = .349), relaparotomy (29.2% vs 40.0%; P = .551), a pancreatic fistula (37.5% vs 28.0%; P = .543), or the length of hospital stay (36.5 ± 19.2 vs 37.4 ± 20.8 days; P = .875), respectively. Regarding IRI, there was no significant difference in peak CRP values (14.1 ± 5.5 vs 16.2 ± 6.0 mg/dL; P = .211).
This single center analysis failed to show that P-PASS significantly predicted pancreas graft survival, postoperative morbidity, or IRI severity. These findings suggested a chance to increase the donor pool using extended-criteria donors.
胰腺移植后缺血再灌注损伤（IRI）很常见，可导致胰腺炎或血栓形成，需要再次剖腹手术，甚至导致移植物丢失。优化供体选择可能会降低IRI的术后发病率。欧洲移植组织预采购胰腺适宜性评分（P-PASS）旨在识别分值<17的理想供体。由于器官短缺，胰腺移植的等待时间在增加，这一问题可通过使用扩大标准供体来解决。我们根据P-PASS分析了我们的胰腺移植术后并发症情况。为反映IRI，我们使用了术后前3天的C反应蛋白（CRP）峰值水平。
2009年1月至2010年7月，我们共移植了52个胰腺移植物，包括50例胰肾联合移植（SPK）、1例肾移植后胰腺移植和1例单纯胰腺移植。3例SPK供体的P-PASS数据缺失。所有移植均采用全身静脉和肠道引流。免疫抑制方案包括使用抗胸腺细胞球蛋白进行抗体诱导以及使用类固醇、他克莫司和霉酚酸酯进行维持治疗。术后前3天的CRP峰值用作IRI的标志物。
我们的供体平均P-PASS为16.4±2.6（范围为12 - 22）。我们将24例接受“理想”供体（P-PASS<17；ID）器官的患者与25例接受扩大标准供体（P-PASS≥17；ED）移植物的患者进行了比较。ID组与ED组移植物丢失发生率无显著差异（20.8%对20.0%；P = 1.0）。比较患者的术后并发症发生率，我们未观察到移植物血栓形成（4.2%对16.0%；P = 0.349）、再次剖腹手术（29.2%对40.0%；P = 0.551）、胰瘘（37.5%对28.0%；P = 0.543）或住院时间（36.5±19.2天对37.4±20.8天；P = 0.875）有显著差异。关于IRI，CRP峰值水平无显著差异（14.1±5.5对16.2±6.0mg/dL；P = 0.211）。
这项单中心分析未能表明P-PASS能显著预测胰腺移植物存活、术后发病率或IRI严重程度。这些发现提示有机会通过使用扩大标准供体来增加供体库。
