Nagai S, Powelson J A, Taber T E, Goble M L, Mangus R S, Fridell J A
Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
Am J Transplant. 2015 Sep;15(9):2456-64. doi: 10.1111/ajt.13287. Epub 2015 Apr 24.
This study evaluated the indications, surgical techniques, and outcomes of allograft pancreatectomy based on a single center experience. Between 2003 and 2013, 47 patients developed pancreas allograft failure, excluding mortality with a functioning pancreas allograft. Early graft loss (within 14 days) occurred in 16, and late graft loss in 31. All patients with early graft loss eventually required allograft pancreatectomy. Nineteen of 31 patients (61%) with late graft loss underwent allograft pancreatectomy. The main indication for early allograft pancreatectomy included vascular thrombosis with or without severe pancreatitis, whereas one recipient required urgent allograft pancreatectomy for gastrointestinal hemorrhage secondary to an arterioenteric fistula. In cases of late allograft pancreatectomy, graft failure with clinical symptoms such as abdominal discomfort, pain, and nausea were the main indications (13/19 [68%]), simultaneous retransplantation without clinical symptoms in 3 (16%), and vascular catastrophes including pseudoaneurysm and enteric arterial fistula in 3 (16%). Postoperative morbidity included one case each of pulmonary embolism leading to mortality, formation of pseudoaneurysm requiring placement of covered stent, and postoperative bleeding requiring relaparotomy eventually leading to femoro-femoral bypass surgery 2 years after allograftectomy. Allograft pancreatectomy can be performed safely, does not preclude subsequent retransplantation, and may be lifesaving in certain instances.
本研究基于单中心经验评估了同种异体胰腺切除术的适应证、手术技术及疗效。2003年至2013年期间，47例患者出现胰腺移植物功能衰竭，不包括胰腺移植物功能正常时的死亡病例。早期移植物丢失（14天内）发生在16例患者中，晚期移植物丢失发生在31例患者中。所有早期移植物丢失的患者最终均需要进行同种异体胰腺切除术。31例晚期移植物丢失患者中有19例（61%）接受了同种异体胰腺切除术。早期同种异体胰腺切除术的主要适应证包括伴有或不伴有严重胰腺炎的血管血栓形成，而1例受者因动脉肠瘘继发胃肠道出血需要紧急进行同种异体胰腺切除术。在晚期同种异体胰腺切除术病例中，主要适应证为出现腹部不适、疼痛和恶心等临床症状的移植物功能衰竭（13/19 [68%]），3例（16%）无临床症状的同时再次移植，3例（16%）出现包括假性动脉瘤和肠动脉瘘在内的血管灾难。术后并发症包括1例因肺栓塞导致死亡，1例因形成假性动脉瘤需要置入覆膜支架，1例术后出血需要再次剖腹手术，最终在异体胰腺切除术后2年进行股-股旁路手术。同种异体胰腺切除术可以安全实施，不排除随后的再次移植，并且在某些情况下可能挽救生命。
