MacCraith Eoin, Davis Niall F, Browne Cliodhna, Mohan Ponnusamy, Hickey David
Department of Urology and Transplant Surgery, Beaumont Hospital, Dublin, Ireland.
Clin Transplant. 2017 Jun;31(6). doi: 10.1111/ctr.12976. Epub 2017 Apr 19.
The incidence of amputation after simultaneous pancreas and kidney (SPK) transplantation ranges from 9.5% to 23% after 5 years of follow-up. The objective of this study was to investigate the incidence and risk factors for amputation in SPK transplant patients compared to kidney transplantation alone (KTA) after a minimum follow-up of 10 years.
An analysis was performed on a prospectively maintained database of 81 SPK transplants and 43 KTA consecutively performed in one center for insulin-dependent diabetes mellitus between December 1992 and January 2006. Primary outcome variables were incidence of amputation per patient, total number of amputations, and type of amputation performed. Data are presented as a mean ± standard deviation.
Seven patients (9%) in the SPK cohort and one patient (2%) in the KTA cohort underwent amputation (P<.001). One amputee had pancreas allograft failure prior to amputation. Fifteen amputations were performed in total and four patients required ≥2 amputations. The latency period between transplantation and amputation was 133.57±49.43 months in the SPK cohort and 168 months in the KTA group.
The incidence of amputation after SPK transplantation is approximately 9% after 10-year follow-up. Patients are at a significantly greater risk of amputation after SPK transplantation compared to KTA for type 1 diabetes despite insulin independence.
胰肾联合移植（SPK）术后5年随访期间截肢发生率为9.5%至23%。本研究的目的是在至少10年的随访后，调查SPK移植患者与单纯肾移植（KTA）患者相比截肢的发生率及危险因素。
对1992年12月至2006年1月在一个中心为胰岛素依赖型糖尿病患者连续进行的81例SPK移植和43例KTA移植的前瞻性维护数据库进行分析。主要结局变量为每位患者的截肢发生率、截肢总数及截肢类型。数据以均值±标准差表示。
SPK队列中有7例患者（9%）接受了截肢手术，KTA队列中有1例患者（2%）接受了截肢手术（P<0.001）。1例截肢患者在截肢前发生了胰腺移植失败。总共进行了15次截肢手术，4例患者需要≥2次截肢。SPK队列中移植与截肢之间的潜伏期为133.57±49.43个月，KTA组为168个月。
SPK移植术后10年随访的截肢发生率约为9%。尽管1型糖尿病患者在SPK移植后胰岛素已恢复自主，但与KTA相比，他们截肢的风险显著更高。
