Al-Qaoud Talal M, Odorico Jon S, Redfield Robert R
Department of Surgery, Division of Transplantation, University of Wisconsin Hospital and Clinics Inc, Madison, Wisconsin, USA.
Curr Opin Organ Transplant. 2018 Aug;23(4):454-460. doi: 10.1097/MOT.0000000000000553.
Pancreas transplantation in type 2 diabetes mellitus (T2DM) candidates remains disproportionately lower than in type 1 diabetes mellitus (T1DM); however, outcomes in carefully selected patients mirrors that of T1DM. Despite the 2014 United Network for Organ Sharing (UNOS) eligibility criteria for simultaneous pancreas/kidney transplant (SPK) transplantation in T2DM patients, an expected increase in the number of transplants was not observed.
In an updated International Pancreas and Transplant Registry (IPTR) analysis, 1514 primary deceased donor pancreas transplants were performed in T2DM recipients [1995-2015, SPK 88%, pancreas after kidney (PAK) 9%, pancreas transplant alone (PTA) 3%]. In contrast to the declining number of SPK transplants for T1DM, the number of primary SPK transplants in T2DM patients is increasing over time in the USA. Improvement over time was noted for T2DM SPK patient and graft survival, and the rate of technical failures decreased, paralleling similar overall trends for pancreas transplants in general. Long-term follow-up data of pancreas outcomes in C-peptide positive vs. negative demonstrate noninferior outcomes. BMI does not appear to impact outcomes in carefully selected T2DM candidates.
The current UNOS regulations that currently limit access of T2DM to pancreas transplantation based on strict BMI criteria and C-peptide levels need to be liberated.
2型糖尿病（T2DM）患者接受胰腺移植的比例仍远低于1型糖尿病（T1DM）患者；然而，经过精心挑选的患者的移植结果与T1DM患者相似。尽管2014年器官共享联合网络（UNOS）制定了T2DM患者同时进行胰腺/肾脏移植（SPK）的资格标准，但并未观察到移植数量的预期增加。
在国际胰腺和移植登记处（IPTR）的一项最新分析中，1514例原发性已故供体胰腺移植手术是在T2DM受者中进行的[1995 - 2015年，SPK占88%，肾后胰腺移植（PAK）占9%，单独胰腺移植（PTA）占3%]。与T1DM患者SPK移植数量的下降相反，美国T2DM患者的原发性SPK移植数量随时间呈上升趋势。T2DM患者SPK移植的患者和移植物生存率随时间有所改善，技术失败率下降，这与一般胰腺移植的总体趋势相似。C肽阳性与阴性患者胰腺移植结果的长期随访数据显示结果无差异。在经过精心挑选的T2DM患者中，体重指数（BMI）似乎不影响移植结果。
目前UNOS基于严格的BMI标准和C肽水平限制T2DM患者接受胰腺移植的规定需要放宽。
