Department of Transplant Medicine, Section of Nephrology, Oslo University Hospital, Oslo, Norway.
Department of Transplant Medicine, Section of Nephrology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway.
Diabetes Res Clin Pract. 2014 Jul;105(1):14-21. doi: 10.1016/j.diabres.2014.03.004. Epub 2014 Mar 15.
Patients with type 1 diabetic end-stage renal disease (ESRD) may be offered single kidney transplantation from a live donor (LDK) or a deceased donor (DDK) to replace the lost kidney function. In the latter setting the patient may also receive a simultaneous pancreas together with a kidney from the same donor (SPK). Also in some cases a pancreas after kidney may be offered to those who have previously received a kidney alone (PAK). The obvious benefit of a successful SPK transplantation is that the patients not only recover from uremia but also obtain normal blood glucose control without use of insulin or other hypoglycemic agents. Accordingly, this combined procedure has become an established treatment for type 1 diabetic patients with ESRD. Adequate long-term blood glucose control may theoretically lead to reduced progression or even reversal of microvascular complications. Another potential beneficial effect may be improvement of patient and kidney graft survival. Development of diabetic complications usually takes a decade to develop and accordingly any potential benefits of a pancreas transplant will not easily be disclosed during the first decade after transplantation. The purpose of the review is to assess the present literature of outcomes after kidney transplantation in patients with diabetic ESRD, with our without a concomitant pancreas transplantation. The points of interest given in this review are microvascular complications, graft outcomes, cardiovascular outcomes and mortality.
1 型糖尿病终末期肾病（ESRD）患者可通过活体供者（LDK）或已故供者（DDK）提供的单个肾脏进行移植，以替代丧失的肾功能。在后一种情况下，患者还可能从同一供者获得同时带有胰腺的肾脏（SPK）。在某些情况下，也可能向那些之前仅接受过肾脏移植的患者提供胰腺-肾脏（PAK）。SPK 移植成功的明显益处是患者不仅摆脱了尿毒症，而且无需使用胰岛素或其他降血糖药物即可获得正常的血糖控制。因此，这种联合手术已成为 1 型糖尿病 ESRD 患者的既定治疗方法。理论上，充分的长期血糖控制可能会导致微血管并发症的进展减缓甚至逆转。另一个潜在的有益影响可能是改善患者和肾脏移植物的存活率。糖尿病并发症的发展通常需要十年的时间，因此，在移植后的头十年内，胰腺移植的任何潜在益处都不容易显现。本综述的目的是评估糖尿病 ESRD 患者在接受或不接受同时胰腺移植的情况下，肾脏移植后的现有文献中有关结果的评估。本综述关注的要点是微血管并发症、移植物结局、心血管结局和死亡率。
