Spetzler Vinzent N, Goldaracena Nicolas, Marquez Max A, Singh Sunita K, Norgate Andrea, McGilvray Ian D, Schiff Jeffrey, Greig Paul D, Cattral Mark S, Selzner Markus
Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada.
Multi Organ Transplant Program, Department of Medicine, Toronto General Hospital, Toronto, ON, Canada.
Transpl Int. 2015 Jun;28(6):720-8. doi: 10.1111/tri.12535. Epub 2015 Feb 23.
Pancreas-kidney transplantation with enteric drainage has become a standard treatment in diabetic patients with renal failure. Leaks of the graft duodenum (DL) remain a significant complication after transplantation. We studied incidence and predisposing factors of DLs in both simultaneous pancreas-kidney (SPK) and pancreas after kidney (PAK) transplantation. Between January 2002 and April 2013, 284 pancreas transplantations were performed including 191 SPK (67.3%) and 93 PAK (32.7%). Patient data were analyzed for occurrence of DLs, risk factors, leak etiology, and graft survival. Of 18 DLs (incidence 6.3%), 12 (67%) occurred within the first 100 days after transplantation. Six grafts (33%) were rescued by duodenal segment resection. Risk factors for a DL were PAK transplantation sequence (odds ratio 3.526, P = 0.008) and preoperative immunosuppression (odds ratio 3.328, P = 0.012). In the SPK subgroup, postoperative peak amylase as marker of preservation/reperfusion injury and recipient pretransplantation cardiovascular interventions as marker of atherosclerosis severity were associated with an increased incidence of DLs. CMV-mismatch constellations showed an increased incidence in the SPK subgroup, however without significance probability. Long-term immunosuppression in PAK transplantation is a major risk factor for DLs. Early surgical revision offers the chance of graft rescue.
胰肾联合移植并行肠道引流术已成为糖尿病肾衰竭患者的标准治疗方法。移植后移植十二指肠漏（DL）仍是一个严重的并发症。我们研究了同期胰肾联合移植（SPK）和肾移植后胰腺移植（PAK）中DL的发生率及相关危险因素。2002年1月至2013年4月期间，共进行了284例胰腺移植，其中包括191例SPK（67.3%）和93例PAK（32.7%）。分析患者数据以了解DL的发生情况、危险因素、漏出病因及移植物存活情况。在18例DL（发生率6.3%）中，12例（67%）发生在移植后的前100天内。6例移植物（33%）通过十二指肠段切除术得以挽救。DL的危险因素为PAK移植顺序（比值比3.526，P = 0.008）和术前免疫抑制（比值比3.328，P = 0.012）。在SPK亚组中，作为保存/再灌注损伤标志物的术后淀粉酶峰值以及作为动脉粥样硬化严重程度标志物的受者移植前心血管干预措施与DL发生率增加相关。CMV配型不匹配在SPK亚组中的发生率有所增加，但无显著统计学意义。PAK移植中的长期免疫抑制是DL的主要危险因素。早期手术修复为挽救移植物提供了机会。
