Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana 46202-5250, USA.
Clin Transplant. 2013 Jul-Aug;27(4):E442-7. doi: 10.1111/ctr.12185.
Coronary artery disease (CAD) is common in patients with type I diabetes and may be associated with worse outcomes in patients undergoing pancreas transplantation (PT). This study evaluates PT patients to determine the pre transplant prevalence of CAD and assesses the post-transplant outcomes including complications and survival.
This study is a retrospective review of PTs from 2003 to 2011. Diagnosis of CAD required cardiac catheterization. Outcomes included: myocardial infarction (MI), stroke, and survival.
There were 405 transplants in 389 patients with median follow-up of 56 months. Pre transplant prevalence of CAD was 19% (n = 74). There was no increased risk of perioperative, 90-d or one-yr mortality for patients with CAD. The CAD group did have increased risk of MI (11% vs. 1%, p < 0.001) and stroke (8% vs. 3%, p = 0.02). Controlling for patient and donor age, and history of CAD, the CAD group had decreased patient survival at five yr (82% vs. 90%, p = 0.09, HR 1.77) by Cox regression.
Patients with type I diabetes and CAD have increased risk of MI and stroke post-pancreas transplant, with decreased five-yr survival. Patients without CAD and a negative pre transplant cardiac evaluation carry a low risk of post-transplant MI.
冠心病（CAD）在 1 型糖尿病患者中较为常见，可能与胰腺移植（PT）患者的预后较差有关。本研究评估了 PT 患者，以确定 CAD 的移植前患病率，并评估了包括并发症和生存率在内的移植后结局。
本研究是对 2003 年至 2011 年期间的 PT 进行的回顾性研究。CAD 的诊断需要进行心脏导管检查。结局包括：心肌梗死（MI）、中风和生存率。
389 例患者中有 405 例接受了移植，中位随访时间为 56 个月。CAD 的移植前患病率为 19%（n = 74）。CAD 患者围手术期、90 天或 1 年死亡率无增加风险。CAD 组 MI（11% vs. 1%，p < 0.001）和中风（8% vs. 3%，p = 0.02）的风险增加。在校正患者和供体年龄以及 CAD 病史后，CAD 组患者的 5 年生存率（82% vs. 90%，p = 0.09，HR 1.77）降低。
1 型糖尿病合并 CAD 的患者在胰腺移植后发生 MI 和中风的风险增加，5 年生存率降低。无 CAD 且移植前心脏评估为阴性的患者发生移植后 MI 的风险较低。
