Lauria Marcio W, Ribeiro-Oliveira Antonio
Department of Internal Medicine (Endocrinology section and Transplantation unit), Federal University of Minas Gerais, Rua Alfredo Balena, 190, 30130-100 Belo Horizonte, MG Brazil.
Clin Diabetes Endocrinol. 2016 Jul 15;2:14. doi: 10.1186/s40842-016-0032-x. eCollection 2016.
Pancreas transplantation (PTX) has been demonstrated to restore long-term glucose homeostasis beyond what can be achieved by intensive insulin therapy or islet transplants. Moreover, PTX has been shown to decrease the progression of the chronic complications of diabetes. However, PTX patients require chronic use of immunosuppressive drugs with potential side effects. The long-term follow-up of PTX patients demands special care regarding metabolic deviations, infectious complications, and chronic rejection. Diabetes and other endocrine metabolic abnormalities following transplantation are common and can increase morbidity and mortality. Previous recipient-related and donor-related factors, as well as other aspects inherent to the transplant, act together in the pathogenesis of those abnormalities. Early recognition of these disturbances is the key to timely treatment; however, adequate tools to achieve this goal are often lacking. In a way, the type of PTX procedure, whether simultaneous pancreas kidney or not, seems to differentially influence the evolution of endocrine and metabolic abnormalities. Further studies are needed to define the best approach for PTX patients. This review will focus on the most common endocrine metabolic disorders seen in the long-term management of PTX: diabetes mellitus, hyperlipidemia, and bone loss. The authors here cover each one of these endocrine topics by showing the evaluation as well as proper management in the follow-up after PTX.
胰腺移植（PTX）已被证明能够恢复长期血糖稳态，其效果超过强化胰岛素治疗或胰岛移植所能达到的水平。此外，PTX已显示可减缓糖尿病慢性并发症的进展。然而，PTX患者需要长期使用具有潜在副作用的免疫抑制药物。对PTX患者的长期随访需要特别关注代谢偏差、感染性并发症和慢性排斥反应。移植后糖尿病和其他内分泌代谢异常很常见，会增加发病率和死亡率。先前与受者和供者相关的因素，以及移植本身的其他方面，共同作用于这些异常的发病机制。早期识别这些紊乱是及时治疗的关键；然而，实现这一目标的适当工具往往缺乏。在某种程度上，PTX手术的类型，无论是否为同期胰肾联合移植，似乎对内分泌和代谢异常的演变有不同影响。需要进一步研究来确定PTX患者的最佳治疗方法。本综述将聚焦于PTX长期管理中最常见的内分泌代谢紊乱：糖尿病、高脂血症和骨质流失。本文作者通过展示PTX术后随访中的评估及适当管理，涵盖了这些内分泌领域的每一个主题。
