Franz Clemens, Görtz Magdalena, Wührl Michael, Kulu Yakup, Hoffmann Katrin, Hackert Thilo, Morath Christian, Zeier Martin, Büchler Markus W, Mehrabi Arianeb
Department of General, Visceral and Transplantation Surgery, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.
Department of Urology, Ruprecht-Karls-University Heidelberg, Heidelberg, China (mainland).
Ann Transplant. 2019 Jul 26;24:439-445. doi: 10.12659/AOT.915852.
BACKGROUND The pre-procurement pancreas suitability score (P-PASS) and the pancreas donor risk index (pDRI) are established predictive scores for graft survival and patient outcome following pancreatic transplantation. This retrospective study aimed to evaluate the predictive value of P-PASS and pDRI following simultaneous pancreas and kidney (SPK) transplantation, or pancreas after kidney (PAK) transplantation, and the clinical impact of donor-specific factors on the postoperative graft and recipient outcome at a single transplant center. MATERIAL AND METHODS The study included 105 patients who underwent SPK (n=104) or PAK (n=4) between 2000 and 2017. Donor-specific and recipient-specific parameters were recorded. Kaplan-Meier analysis and Cox regression analysis were used to assess the outcome after transplantation. RESULTS Overall, the mean 1-year and 5-year pancreas graft survival and patient survival rates were 78.7% and 93.2%, and 76.9% and 90.0%, respectively. The postoperative outcome in patients with a P-PASS score of <17 was not significantly different when compared with patients with a score of ≥17. A P-PASS score of ≥17 was significantly associated with early pancreas graft loss (p=0.04). There was no significant difference in postoperative outcome between patients with high pDRI and low pDRI. Smoking of donor (p=0.046) was a risk factor and coronary heart disease of recipient (p=0.003) had a significant effect on survival of pancreas graft. CONCLUSIONS This study showed that P-PASS and pDRI were not reliable predictors of outcome after pancreas transplantation and that specific characteristics of the donor and recipient must be evaluated when predicting the outcome of pancreas transplantation.
胰腺移植前采购适宜性评分（P-PASS）和胰腺供体风险指数（pDRI）是用于预测胰腺移植后移植物存活和患者预后的评分系统。本回顾性研究旨在评估P-PASS和pDRI在同期胰肾联合移植（SPK）或肾后胰腺移植（PAK）后的预测价值，以及在单一移植中心供体特异性因素对术后移植物和受者预后的临床影响。
本研究纳入了2000年至2017年间接受SPK（n=104）或PAK（n=4）的105例患者。记录供体特异性和受体特异性参数。采用Kaplan-Meier分析和Cox回归分析评估移植后的预后。
总体而言，胰腺移植物1年和5年的平均存活率及患者生存率分别为78.7%和93.2%，以及76.9%和90.0%。P-PASS评分<17的患者与评分≥17的患者相比，术后预后无显著差异。P-PASS评分≥17与早期胰腺移植物丢失显著相关（p=0.04）。高pDRI和低pDRI患者的术后预后无显著差异。供体吸烟（p=0.046）是一个危险因素，受体冠心病（p=0.003）对胰腺移植物存活有显著影响。
本研究表明，P-PASS和pDRI并非胰腺移植后预后的可靠预测指标，在预测胰腺移植预后时必须评估供体和受体的特定特征。
