Ziaja J, Kolonko A, Kamińska D, Chudek J, Owczarek A J, Kujawa-Szewieczek A, Kuriata-Kordek M, Krzyżowska K, Badura J, Czerwiński J, Jęrdusik E, Król R, Klinger M, Więcek A, Cierpka L
Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland.
Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland.
Transplant Proc. 2016 Jun;48(5):1681-6. doi: 10.1016/j.transproceed.2016.01.082.
Kidney transplantation (KTx) markedly reduces mortality in patients with end-stage kidney disease (ESKD) caused by type 1 diabetes mellitus (T1DM). The outstanding issue is whether transplantation should be limited only to KTx, with further insulinotherapy, or combined with pancreas transplantation in patients with ESKD/T1DM. The goal of this study was to compare the results of simultaneous pancreas-kidney transplantation (SPKTx) and deceased donor KTx and to identify factors affecting patient and kidney graft survival in patients with ESKD/T1DM.
Eighty-seven deceased donor KTx and 66 SPKTx operated on in the Silesia region of Poland between 1998 and 2013 were included in the retrospective analysis.
During the mean 6.7 ± 3.6 years of follow-up, fewer cardiovascular episodes were observed in SPKTx recipients than in KTx recipients (1.5% vs 12.6%; P < .05). Five-year patient survival (80.7% in SPKTx vs 77.5% in KTx) and kidney graft survival (66.1% in SPKTx vs 70.4% in KTx) did not differ between study groups. There were no differences in patient survival (log-rank test, P = .99) or kidney graft survival (P = .99) based on Kaplan-Meier curves. Multivariable Cox proportional hazard analysis failed to identify factors explaining patient and kidney graft survival. Five-year pancreas graft survival was 58.9%. SPKTx recipients had significantly higher estimated glomerular filtration rates during the 7-year posttransplant period and less frequently developed proteinuria (6.1% vs 23%; P < .01).
Pancreas transplantation reduced cardiovascular risk and prevented the development of proteinuria but did not improve patient and kidney graft survival in recipients with T1DM in the 7-year follow-up period.
肾移植（KTx）显著降低了1型糖尿病（T1DM）所致终末期肾病（ESKD）患者的死亡率。目前的突出问题是，对于ESKD/T1DM患者，移植是否应仅限于肾移植并辅以进一步的胰岛素治疗，还是应联合胰腺移植。本研究的目的是比较同期胰肾联合移植（SPKTx）和尸体供肾肾移植的结果，并确定影响ESKD/T1DM患者及其肾移植存活的因素。
对1998年至2013年在波兰西里西亚地区接受手术的87例尸体供肾肾移植和66例SPKTx进行回顾性分析。
在平均6.7±3.6年的随访期间，SPKTx受者的心血管事件发生率低于肾移植受者（1.5%对12.6%；P<.05）。研究组间5年患者生存率（SPKTx为80.7%，肾移植为77.5%）和肾移植存活率（SPKTx为66.1%，肾移植为70.4%）无差异。根据Kaplan-Meier曲线，患者生存率（对数秩检验，P=.99）或肾移植存活率（P=.99）无差异。多变量Cox比例风险分析未能确定解释患者和肾移植存活的因素。5年胰腺移植存活率为58.9%。SPKTx受者在移植后7年内估计肾小球滤过率显著更高，蛋白尿发生率更低（6.1%对23%；P<.01）。
胰腺移植降低了心血管风险，预防了蛋白尿的发生，但在7年随访期内，并未改善T1DM受者的患者和肾移植存活率。
