Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Transplantation. 2011 Oct 15;92(7):796-801. doi: 10.1097/TP.0b013e31822dc36b.
Early pancreas graft failure after simultaneous pancreas and kidney (SPK) transplantation is common. We studied the impact of early pancreas graft failure on long-term kidney and patient survival.
We included all primary SPK transplants performed in the United States between January 1, 2000, and December 31, 2007, who had maintained kidney graft function at 90 days posttransplantation. Kaplan-Meier and Cox multivariate analyses were performed. The causes of death between the two cohorts were compared.
A total of 6282 SPK recipients were included in the analyses. Of those, 470 had lost pancreas graft within the first 90 days largely related to pancreas graft thrombosis. Early pancreas graft failure was associated with lower subsequent kidney graft and patient survival (log-rank, P=0.02 and P<0.001, respectively). Multivariate regression analyses demonstrated a 70% higher risk of kidney graft failure after 3 years (adjusted hazard ratio 1.69; 95% CI 1.08, 2.66; P=0.022) and more than doubled the risk for death (adjusted hazard ratio 2.18; 95% CI 1.67, 2.85; P<0.001) among SPK recipients with early pancreas graft failure. The causes of death were similar between the two cohorts.
Early pancreas graft failure in SPK transplant recipients is associated with an increased risk for subsequent kidney failure and death. Optimization of therapeutic interventions after early pancreas graft failure is needed.
在胰肾联合移植（SPK）后，早期胰腺移植物衰竭很常见。我们研究了早期胰腺移植物衰竭对长期肾脏和患者生存的影响。
我们纳入了 2000 年 1 月 1 日至 2007 年 12 月 31 日期间在美国进行的所有原发性 SPK 移植，这些患者在移植后 90 天内保持了肾脏移植物功能。进行了 Kaplan-Meier 和 Cox 多变量分析。比较了两组之间的死亡原因。
共有 6282 例 SPK 受者纳入分析。其中，470 例在最初 90 天内失去了胰腺移植物，主要与胰腺移植物血栓形成有关。早期胰腺移植物衰竭与随后的肾脏移植物和患者生存率降低相关（对数秩检验，P=0.02 和 P<0.001）。多变量回归分析显示，3 年后肾脏移植物衰竭的风险增加了 70%（调整后的危险比 1.69；95%CI 1.08，2.66；P=0.022），死亡风险增加了一倍以上（调整后的危险比 2.18；95%CI 1.67，2.85；P<0.001）。两组的死亡原因相似。
SPK 移植受者的早期胰腺移植物衰竭与随后发生肾衰竭和死亡的风险增加相关。需要优化早期胰腺移植物衰竭后的治疗干预措施。
