Grochowiecki T, Gałazka Z, Frunze S, Nazarewski S, Jakimowicz T, Paczek L, Durlik M, Lao M, Szmidt J
Department of General, Vascular, and Transplant Surgery, Warsaw Medical University, and Department of Gastrointestinal Surgery and Transplantology, Central Clinical Hospital of Ministry of Foreign Affairs, Warsaw, Poland.
Transplant Proc. 2011 Oct;43(8):3102-4. doi: 10.1016/j.transproceed.2011.08.029.
Simultaneous pancreas and preemptive kidney transplantation (SPpreKT) seems to be the optimal treatment for the patients with diabetes type 1 who are progressing to end-stage renal disease. On the other hand, surgical complications with a high rate of relaparatomy are a limiting factor in pancreas transplantation.
Comparison of severity of surgical complications was performed between a group of preemptive (SPpreKT group) and nonpreemptive recipients of SPKT (SPKT group).
Between 1988 and 2010, we performed 112 SPKTs including 25 preemptive recipients (22.3%). The SPKT Group included 87 recipients (77.7%). The severity of complications was classified according to a modified Clavien scale: grade I, no complication; grade II, drug therapy; grade IIIA, invasive intervention not requiring general anesthesia; grade IIIB, invasive intervention requiring general anesthesia; grade IVA, graft failure; and grade IVB, death.
Among the SPpreKT group, 64% of recipients were free from postoperative complications compared with 40.3% of the SPKT group (P<.01). Among the SPKT group, 52 recipients (59.7%) developed 58 postoperative complications, including 15 (17.3%) deaths due to graft pancreatitis (80%) or pancreatic fistula (20%). Among the SPpreKT group, 9 recipients developed 9 complications. None of the preemptively transplanted group subjects experienced a lethal complication. Among the SPpreKT group, the most severe complication was graft pancreatitis leading to graft removal in 2 recipients.
Recipients of preemptive SPKT developed significantly fewer postoperative complications, especially deaths. However the rates of mild (II, IIIA) and moderate (IIIB) complications as well as graft failures (IVA) were similar to the nonpreemptive group.
同时进行胰腺移植和抢先肾移植（SPpreKT）似乎是进展为终末期肾病的1型糖尿病患者的最佳治疗方法。另一方面，手术并发症以及较高的再次剖腹手术率是胰腺移植的一个限制因素。
对抢先接受者组（SPpreKT组）和非抢先接受者的SPKT组（SPKT组）的手术并发症严重程度进行比较。
1988年至2010年期间，我们进行了112例SPKT手术，其中包括25例抢先接受者（22.3%）。SPKT组包括87例接受者（77.7%）。根据改良的Clavien量表对并发症的严重程度进行分类：I级，无并发症；II级，药物治疗；IIIA级，不需要全身麻醉的侵入性干预；IIIB级，需要全身麻醉的侵入性干预；IVA级，移植物功能衰竭；IVB级，死亡。
在SPpreKT组中，64%的接受者无术后并发症，而SPKT组为40.3%（P<0.01）。在SPKT组中，52例接受者（59.7%）发生了58例术后并发症，包括15例（17.3%）因移植物胰腺炎（80%）或胰瘘（20%）死亡。在SPpreKT组中，9例接受者发生了9例并发症。抢先移植组的受试者均未发生致命并发症。在SPpreKT组中，最严重的并发症是移植物胰腺炎，导致2例接受者的移植物被切除。
抢先进行SPKT的接受者术后并发症明显较少，尤其是死亡。然而，轻度（II级、IIIA级）和中度（IIIB级）并发症以及移植物功能衰竭（IVA级）的发生率与非抢先组相似。
