1 型和 2 型糖尿病患者接受胰肾联合移植的短期和长期代谢结果。
Short and long-term metabolic outcomes in patients with type 1 and type 2 diabetes receiving a simultaneous pancreas kidney allograft.
机构信息
Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Dresden, Fetcherstrasse 74, 01307, Dresden, Germany.
出版信息
BMC Endocr Disord. 2020 Feb 27;20(1):30. doi: 10.1186/s12902-020-0506-9.
BACKGROUND
In contrast to insulin-dependent type 1 diabetes mellitus (T1DM), the indication for Simultaneous pancreas-kidney transplantation (SPK) in patients with type 2 diabetes mellitus (T2DM) is still ambiguous and wisely Eurotransplant (ET) only granted transplant-permission in a selected group of patients. However, with regard to improvement of metabolic conditions SPK might still be a considerable treatment option for lean insulin dependent type 2 diabetics suffering from renal disease.
METHODS
Medical data (2001-2013) from all consecutive T1DM and T2DM patients who received a SPK or kidney transplant alone (KTA) at the University Hospital of Leipzig were analyzed. Donor, recipients and long-term endocrine, metabolic and graft outcomes were investigated for T1DM and T2DM-SPK recipients (transplanted upon a special request allocation by ET) and T2DM patients who received a KTA during the same period.
RESULTS
Eighty nine T1DM and 12 T2DM patients received a SPK and 26 T2DM patients received a KTA. Patient survival at 1 and 5 years was 89.9 and 88.8% for the T1DM group, 91.7 and 83.3% for the T2DM group, and 92.3 and 69.2% for the T2DM KTA group, respectively (p < 0.01). Actuarial pancreas graft survival for SPK recipients at 1 and 5 years was 83.1 and 78.7% for the T1DM group and 91.7 and 83.3% for the T2DM group, respectively (p = 0.71). Kidney allograft survival at 5 years was 79.8% for T1DM, 83.3% for T2DM, and 65.4% for T2DM KTA (p < 0.01). Delayed graft function (DGF) rate was significantly higher in type 2 diabetics received a KTA. Surgical, immunological and infectious complications showed similar results for T1DM and T2DM recipients after SPK transplant and KTA, respectively. With regard to the lipid profile, the mean high-density lipoprotein (HDL)- cholesterol levels were significantly higher in T1DM recipients compared to T2DM patients before transplantation (p = 0.02) and remained significantly during follow up period.
CONCLUSION
Our data demonstrate that with regard to metabolic function a selected group of patients with T2DM benefit from SPK transplantation. Consensus guidelines and further studies for SPK transplant indications in T2DM patients are still warranted.
背景
与胰岛素依赖型 1 型糖尿病（T1DM）相比，2 型糖尿病（T2DM）患者进行胰肾联合移植（SPK）的适应证仍不明确，明智的是，欧洲器官移植中心（ET）仅在一组选定的患者中授予移植许可。然而，就代谢状况的改善而言，SPK 可能仍然是患有肾脏疾病的瘦型胰岛素依赖型 2 型糖尿病患者的一种重要治疗选择。
方法
分析了莱比锡大学医院所有连续接受 SPK 或单独肾移植（KTA）的 T1DM 和 T2DM 患者的医疗数据（2001-2013 年）。对 T1DM 和 T2DM-SPK 受者（根据 ET 的特殊请求分配进行移植）和同期接受 KTA 的 T2DM 患者的供者、受者以及长期内分泌、代谢和移植物结局进行了调查。
结果
89 例 T1DM 和 12 例 T2DM 患者接受了 SPK，26 例 T2DM 患者接受了 KTA。T1DM 组患者 1 年和 5 年的存活率分别为 89.9%和 88.8%，T2DM 组为 91.7%和 83.3%，T2DM KTA 组为 92.3%和 69.2%（p<0.01）。SPK 受者胰腺移植物 1 年和 5 年的存活率分别为 T1DM 组的 83.1%和 78.7%，T2DM 组的 91.7%和 83.3%（p=0.71）。T1DM 患者的肾移植 5 年存活率为 79.8%，T2DM 患者为 83.3%，T2DM KTA 患者为 65.4%（p<0.01）。T2DM 接受 KTA 的患者发生延迟移植物功能（DGF）的比例明显较高。SPK 移植和 KTA 后，T1DM 和 T2DM 受者的手术、免疫和感染并发症均有类似结果。就血脂谱而言，T1DM 受者的平均高密度脂蛋白（HDL）-胆固醇水平在移植前明显高于 T2DM 患者（p=0.02），并在随访期间保持显著水平。
结论
我们的数据表明，对于代谢功能，一组选定的 T2DM 患者受益于 SPK 移植。对于 T2DM 患者的 SPK 移植适应证，仍需要共识指南和进一步的研究。
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