Nephrology and Kidney Transplantation Department, Hospital Clinic de Barcelona, Barcelona, Spain.
Endocrinology Department, Hospital Clinic de Barcelona, Barcelona, Spain.
BMJ Open Diabetes Res Care. 2020 Mar;8(1). doi: 10.1136/bmjdrc-2019-000916.
Improvement in insulin alternatives is leading to a delayed presentation of microvascular and macrovascular complications of diabetes. The objective of this study was to evaluate the long-term outcomes of older (≥50 years) diabetic patients who receive a pancreas transplantation (PT).
We retrospectively evaluated all 338 PTs performed at our center between 2000 and 2016 (mean follow-up 9.4±4.9 years). Recipient and graft survivals were estimated for up to 10 years after PT. Major adverse cardiovascular events (MACEs) before and after PT were included in the analysis.
Thirty-nine patients (12%) were ≥50 years old (52.7±2.3 years) at the day of PT, of which 29 received a simultaneous pancreas-kidney transplantation (SPK) and 10 a pancreas after kidney transplantation (PAK). SPK recipients were first transplants, whereas in the PAK up to 50% were pancreas re-transplantations. Recipient and pancreas graft survivals at 10 years were similar between the group <50 years old and the older group for both SPK and PAK (log-rank p>0.05). The prevalence of MACE prior to PT was similar between both groups (31% vs 29%). Following PT, older recipients presented inferior post-transplant MACE-free survival. In a multivariate regression model, diabetes vintage (HR 1.054, p=0.03) and pre-transplantation MACE (HR 1.98, p=0.011), but not recipient age (HR 1.45, p=0.339), were associated with post-transplant MACE.
Long-term survival of older pancreas transplant recipients are similar to younger counterparts. Diabetes vintage, but not age, increased the risk of post-transplantation MACE. These results suggest pancreas transplantation is a valuable treatment alternative to older diabetic patients.
胰岛素替代物的改进导致糖尿病微血管和大血管并发症的出现时间延迟。本研究的目的是评估在我们中心接受胰腺移植（PT）的老年（≥50 岁）糖尿病患者的长期结果。
我们回顾性评估了 2000 年至 2016 年期间在我们中心进行的所有 338 例 PT（平均随访 9.4±4.9 年）。估计了 PT 后长达 10 年的受者和移植物存活率。分析了 PT 前后的主要不良心血管事件（MACE）。
39 例患者（12%）在 PT 当天年龄≥50 岁（52.7±2.3 岁），其中 29 例接受了同时胰腺-肾脏移植（SPK），10 例接受了肾脏移植后的胰腺移植（PAK）。SPK 受者为首次移植，而 PAK 中高达 50%为胰腺再次移植。SPK 和 PAK 中，年龄较大组与年龄较小组的 10 年受者和胰腺移植物存活率相似（对数秩检验 p＞0.05）。PT 前两组的 MACE 患病率相似（31%比 29%）。PT 后，年龄较大的受者移植后无 MACE 生存率较低。在多变量回归模型中，糖尿病病史（HR 1.054，p=0.03）和移植前 MACE（HR 1.98，p=0.011），而不是受者年龄（HR 1.45，p=0.339），与移植后 MACE 相关。
老年胰腺移植受者的长期存活率与年轻受者相似。糖尿病病史，但不是年龄，增加了移植后 MACE 的风险。这些结果表明，胰腺移植是老年糖尿病患者的一种有价值的治疗选择。
