Department of Visceral, Transplant, and Thoracic Surgery, Innsbruck Medical University, Austria.
Transplantation. 2013 Apr 27;95(8):1030-6. doi: 10.1097/TP.0b013e3182861945.
Simultaneous pancreas-kidney (SPK) transplantation is widely accepted as an optimal therapeutic option for patients with type 1 diabetes mellitus (T1DM) and end-stage renal disease, but the indication for patients with type 2 diabetes mellitus (T2DM) is still controversially discussed.
Twenty-one T2DM recipients of a first combined pancreas-kidney graft performed at our center during a 9-year period were retrospectively analyzed with regard to demographic characteristics; cardiovascular risk factors; surgical, immunological, and infectious complications; and patient and graft survivals and compared with T1DM recipients (n=195) and 32 T2DM patients who received a kidney transplant alone (KTA) during the same period.
Patient survival at 1 and 5 years was 96.9% and 91.6% for the T1DM group, 90.5% and 80.1% for the T2DM group, and 87.1% and 54.2% for the T2DM KTA group, respectively (P<0.001). Actuarial pancreas graft survival for SPK recipients at 1 and 5 years was calculated to be 92.6% and 80.7% for the T1DM group and 81.0% and 75.9% for the T2DM group, respectively (P=0.19). Kidney allograft survival at 5 years was 83.6% for T1DM, 80.4% for T2DM, and 52.7% for T2DM KTA (P<0.0001). Multivariate analysis adjusting for donor and recipient age, secondary complications of diabetes, body mass index, waiting time, cold ischemic time, delayed graft function, and coronary risk factors showed that differences did not remain statistically significant.
Favorable results can be achieved with SPK transplantation in type 2 diabetics with a low coronary risk profile. A high cardiac death rate impacts results of KTA and calls for stringent selection.
胰肾联合（SPK）移植被广泛认为是 1 型糖尿病（T1DM）和终末期肾病患者的最佳治疗选择，但 2 型糖尿病（T2DM）患者的适应证仍存在争议。
对我院 9 年内首次接受胰肾联合移植的 21 例 T2DM 患者的人口统计学特征、心血管危险因素、手术、免疫和感染并发症、患者和移植物存活率进行回顾性分析，并与 T1DM 患者（n=195）和同期 32 例接受单独肾移植（KTA）的 T2DM 患者进行比较。
T1DM 组患者 1 年和 5 年存活率分别为 96.9%和 91.6%，T2DM 组分别为 90.5%和 80.1%，T2DM KTA 组分别为 87.1%和 54.2%（P<0.001）。SPK 受者胰腺移植物 1 年和 5 年的累积存活率分别计算为 T1DM 组 92.6%和 80.7%，T2DM 组 81.0%和 75.9%（P=0.19）。T1DM 患者的肾移植 5 年存活率为 83.6%，T2DM 患者为 80.4%，T2DM KTA 患者为 52.7%（P<0.0001）。多变量分析调整供体和受体年龄、糖尿病的继发性并发症、体重指数、等待时间、冷缺血时间、延迟移植物功能和冠状动脉危险因素后，差异无统计学意义。
对于低冠状动脉风险的 2 型糖尿病患者，SPK 移植可获得良好的效果。高心脏死亡率影响 KTA 的结果，并需要严格选择。
