Ziaja J, Chudek J, Kolonko A, Kamińska D, Kujawa-Szewieczek A, Kuriata-Kordek M, Król R, Klinger M, Wiecek A, Patrzałek D, Cierpka L
Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland.
Transplant Proc. 2011 Oct;43(8):3097-101. doi: 10.1016/j.transproceed.2011.08.020.
Simultaneous pancreas-kidney transplantation (SPK) is an alternative to kidney transplantation (KTx) for type 1 diabetic patients with end-stage kidney disease. However, a fair comparison of SPK and KTx is difficult because of significant differences in donor, recipient, and transplantation procedure parameters. The aim of this study was to compare the early and long-term outcomes of SPK versus KTx in southwest Poland.
Thirty-five diabetic dialysis patients who had SPK and 64 patients who had KTx were included in the analysis.
SPK recipients were younger (38±6 years versus 42±9 years) and received organs from younger donors (25±7 versus 43±12 years) compared to the KTx group. They had shorter kidney cold ischemia time (9±2 hours versus 22±7 hours) but worse HLA class II mismatches (1.4±0.6 versus 1.0±0.5). In the early postoperative period, three patients died from the SPK group and one patient died from the KTx group. Additionally, two SPK patients lost their pancreatic grafts, and five KTx patients lost their kidney grafts. One-year patient survival rates for the SPK and KTx groups were 88% and 98%, respectively, and 5-year, 81% and 93%, respectively. One-year kidney graft survivals rates for the SPK and KTx groups were 100% and 89%, respectively, and 5-years, 89% and 81%, respectively. One-year insulin-free survival among SPK patients was 90% and the 5-year survival rate was 76%. Excretory function of the transplanted kidneys was better among SPK group; however, the difference reached statistical significance only in posttransplant years 2 and 3: 63.5±20.1 versus 50.3±19.7 and 64.9±12.9 versus 51.6±21.8 mL/min/1.73 m2 for SPK and KTx, respectively.
Normoglycemia in SPK recipients did not improve patient survival at 5 years. The worse HLA compatibility in the SPK group did not lead to impaired kidney graft survival compared to KTx. Better kidney graft function among SPK recipients probably resulted from a more restrictive donor selection.
对于终末期肾病的1型糖尿病患者，胰肾联合移植（SPK）是肾移植（KTx）的一种替代方案。然而，由于供体、受体和移植手术参数存在显著差异，很难对SPK和KTx进行公平比较。本研究的目的是比较波兰西南部SPK与KTx的早期和长期结果。
分析纳入了35例接受SPK的糖尿病透析患者和64例接受KTx的患者。
与KTx组相比，SPK受者更年轻（38±6岁对42±9岁），接受的器官来自更年轻的供体（25±7岁对43±12岁）。他们的肾脏冷缺血时间更短（9±2小时对22±7小时），但HLA II类错配更严重（1.4±0.6对1.0±0.5）。术后早期，SPK组有3例患者死亡，KTx组有1例患者死亡。此外，2例SPK患者失去了胰腺移植物，5例KTx患者失去了肾脏移植物。SPK组和KTx组的1年患者生存率分别为88%和98%，5年生存率分别为81%和93%。SPK组和KTx组的1年肾移植生存率分别为100%和89%，5年生存率分别为89%和81%。SPK患者的1年无胰岛素生存率为90%，5年生存率为76%。SPK组移植肾的排泄功能更好；然而，差异仅在移植后第2年和第3年达到统计学意义：SPK组和KTx组分别为63.5±20.1对50.3±19.7以及64.9±12.9对51.6±21.8 mL/min/1.73 m2。
SPK受者的血糖正常并未提高5年患者生存率。与KTx相比，SPK组较差的HLA相容性并未导致肾移植生存率受损。SPK受者更好的肾移植功能可能源于更严格的供体选择。
