Redfield Robert R, Scalea Joseph R, Odorico Jon S
Division of Transplantation, Department of Surgery, University of Wisconsin -Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA *Joseph R. Scalea and Robert R. Redfield contributed equally to the writing of this article.
Curr Opin Organ Transplant. 2015 Feb;20(1):94-102. doi: 10.1097/MOT.0000000000000146.
Important trends are being observed in pancreas transplantation in the USA. We will describe recent trends in simultaneous pancreas kidney (SPK) transplantation related to immunosuppression, treatment of rejection, and transplantation for patients of advanced age and C-peptide positive diabetes.
Rates of pancreas transplantation have declined, despite improved pancreatic graft outcomes. Regarding immunosuppression, trends in SPK transplantation include T-cell depletion induction therapy, waning mammalian target of rapamycin inhibitor use and steroid use in greater than 50% of pancreas transplant recipients with few patients undergoing late steroid weaning. Rejection of the pancreas may be discordant with the kidney after SPK and there is a greater appreciation of antibody-mediated rejection of the pancreas allograft. De-novo donor-specific antibody without graft dysfunction remains an active area of study, and the treatment for this condition is unclear. SPKs are being performed with greater frequency in type 2 diabetes mellitus patients and in patients of advanced age, with exemplary results.
The current state of the art in SPK transplantation is yielding superb and improving results.
综述目的：美国胰腺移植领域正在出现一些重要趋势。我们将描述同期胰肾联合移植（SPK）在免疫抑制、排斥反应治疗以及老年和C肽阳性糖尿病患者移植方面的近期趋势。
最新发现：尽管胰腺移植的移植物预后有所改善，但胰腺移植的比率仍在下降。在免疫抑制方面，SPK移植的趋势包括T细胞清除诱导疗法、雷帕霉素靶蛋白抑制剂使用减少以及超过50%的胰腺移植受者使用类固醇，很少有患者进行晚期类固醇撤减。SPK后胰腺的排斥反应可能与肾脏不一致，并且对胰腺同种异体移植的抗体介导排斥反应有了更多认识。无移植物功能障碍的新生供者特异性抗体仍然是一个活跃的研究领域，对此情况的治疗尚不清楚。SPK在2型糖尿病患者和老年患者中的实施频率越来越高，效果堪称典范。
总结：SPK移植的当前技术水平正在产生卓越且不断改善的结果。
