Ziaja J, Król R, Pawlicki J, Heitzman M, Wilk J, Kowalik A, Bożek-Pająk D, Sekta S, Cierpka L
Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Warsaw, Poland.
Transplant Proc. 2011 Oct;43(8):3092-6. doi: 10.1016/j.transproceed.2011.08.072.
The success of simultaneous pancreas-kidney transplantation (SPK) depends in a large degree on avoidance of surgical complications in the early postoperative period. The aim of the study was to analyze the Pre-procurement Pancreas Allocation Suitability Score (P-PASS) and the deceased donor parameters included within it as risk factors for early surgical complications after SPK.
Forty-six consecutive donors whose kidney and pancreas were simultaneously transplanted were included in the study.
Donor age was older among recipients who lost their pancreatic grafts: 30.4±6.9 versus 24.1±6.9 years. Donor age was also older among recipients who lost their pancreatic grafts or died compared with those discharged with a functioning graft: 29.3±5.7 versus 24.0±6.9 years. Donor body mass index (BMI) was higher among patients who died compared with those who were discharged: 25.3±1.1 versus 23.2±2.5 kg/m2. P-PASS was higher in patients who lost their pancreatic grafts (17.6±2.1 vs 15.2±1.8) or died (15.3±1.9 vs 17.2±1.9), or lost pancreatic graft or died (15.2±1.8 vs 17.0±2.2) or with intra-abdominal infections (IAI; 17.1±1.7 vs 15.0±1.8). The incidence of donors≥30 years old was higher among recipients with IAI (45.4% vs 14.3%; P=.04). An higher rate of donors with P-PASS>16 was revealed among patients who lost their pancreatic grafts (26.7% vs 3.2%), died (26.7% vs 3.2%), lost the pancreatic graft or died (33.3% vs 6.4%), or experienced IAI (46.7% vs 9.7%). Multivariate logistic regression analysis revealed P-PASS (odds ratio 2.57; P=.014) and serum sodium (odds ration, 0.91; P=.048) to be important predictors of IAI development.
Older age and higher BMI among deceased donors increased the risk of IAI, pancreatic graft loss, or recipient death after SPK. Transplantation of a pancreas from a donor with a low P-PASS score was associated with a lower risk of surgical complications after SPK.
胰肾联合移植（SPK）的成功在很大程度上取决于术后早期避免手术并发症。本研究的目的是分析获取前胰腺分配适宜性评分（P-PASS）及其所包含的已故供体参数作为SPK术后早期手术并发症的危险因素。
本研究纳入了46例连续进行肾和胰腺联合移植的供体。
胰腺移植失败的受者的供体年龄较大：30.4±6.9岁 vs 24.1±6.9岁。与移植功能良好出院的受者相比，胰腺移植失败或死亡的受者的供体年龄也较大：29.3±5.7岁 vs 24.0±6.9岁。死亡患者的供体体重指数（BMI）高于出院患者：25.3±1.1 vs 23.2±2.5kg/m²。胰腺移植失败的患者（17.6±2.1 vs 15.2±1.8）、死亡患者（15.3±1.9 vs 17.2±1.9）、胰腺移植失败或死亡患者（15.2±1.8 vs 17.0±2.2）或发生腹腔内感染（IAI）的患者（17.1±1.7 vs 15.0±1.8）的P-PASS较高。IAI患者中≥30岁供体的发生率更高（45.4% vs 14.3%；P=0.04）。胰腺移植失败的患者（26.7% vs 3.2%）、死亡患者（26.7% vs 3.2%）、胰腺移植失败或死亡患者（33.3% vs 6.4%）或发生IAI的患者（46.7% vs 9.7%）中，P-PASS>16的供体比例更高。多因素逻辑回归分析显示P-PASS（比值比2.57；P=0.014）和血清钠（比值比，0.91；P=0.048）是IAI发生的重要预测因素。
已故供体年龄较大和BMI较高会增加SPK术后IAI、胰腺移植失败或受者死亡的风险。来自P-PASS评分低的供体的胰腺移植与SPK术后较低的手术并发症风险相关。
