Giorgakis Emmanouil, Mathur Amit K, Chakkera Harini A, Reddy Kunam S, Moss Adyr A, Singer Andrew L
Division of Transplant, Department of Surgery, Mayo Clinic, Phoenix, AZ 85054, United States.
Division of Nephrology, Department of Internal Medicine, Mayo Clinic, Phoenix, AZ 85054, United States.
World J Transplant. 2018 Nov 30;8(7):237-251. doi: 10.5500/wjt.v8.i7.237.
Pancreas transplant has evolved significantly in recent years. It has now become a viable treatment option on type 1 diabetic patients with poorly controlled diabetes on conventional treatment, insulin intolerance, hypoglycaemia unawareness, brittle diabetes and/ or end-stage kidney disease. The purpose of this review is to provide an overview of pancreas transplant historical origins and current barriers to broader utilization of pancreata for transplant, with a focus on areas for future improvement to better pancreas transplant care. Donor pancreata remain underutilized; pancreatic allograft discard rates remain close to 30% in the United States. Donations after cardiac death (DCD) pancreata are seldom procured. Study groups from Europe and the United Kingdom showed that procurement professionalization and standardization of technique, as well as development of independent regional procurement teams might increase organ procurement efficiency, decrease discards and increase pancreatic allograft utilization. Pancreas transplant programs should consider exploring pancreas procurement opportunities on DCD and obese donors. Selected type 2 diabetics should be considered for pancreas transplant. Longer follow-up studies need to be performed in order to ascertain the long-term cardiovascular and quality of life benefits following pancreas transplant; the outcomes of which might eventually spearhead advocacy towards broader application of pancreas transplant among diabetics.
近年来，胰腺移植有了显著发展。如今，对于常规治疗血糖控制不佳、胰岛素不耐受、低血糖无意识、脆性糖尿病和/或终末期肾病的1型糖尿病患者，胰腺移植已成为一种可行的治疗选择。本综述的目的是概述胰腺移植的历史渊源以及目前胰腺移植广泛应用的障碍，重点关注未来可改进的领域，以更好地开展胰腺移植治疗。供体胰腺的利用率仍然较低；在美国，胰腺同种异体移植的丢弃率仍接近30%。心脏死亡后捐赠（DCD）的胰腺很少被获取。来自欧洲和英国的研究小组表明，采购专业化、技术标准化以及独立区域采购团队的发展可能会提高器官采购效率、减少丢弃率并增加胰腺同种异体移植的利用率。胰腺移植项目应考虑探索DCD供体和肥胖供体的胰腺获取机会。部分2型糖尿病患者应考虑进行胰腺移植。需要进行更长时间的随访研究，以确定胰腺移植后的长期心血管益处和生活质量改善情况；其结果最终可能推动在糖尿病患者中更广泛地应用胰腺移植。
