Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA.
Division of Nephrology, Mayo Clinic, Phoenix, AZ, USA.
Clin Transplant. 2021 Jan;35(1):e14138. doi: 10.1111/ctr.14138. Epub 2020 Nov 20.
Early pancreas loss in simultaneous pancreas-kidney (SPK) transplants has been associated with longer perioperative recovery and reduced kidney allograft function. We assessed the impact of early pancreas allograft failure on transplant outcomes in a contemporary cohort of SPK patients (n = 218). Early pancreas allograft loss occurred in 12.8% (n = 28) of recipients. Delayed graft function (DGF) was more common (21.4% vs. 7.4%, p = 0.03) in the early pancreas loss group, but there were no differences in hospital length of stay (median 6.5 vs. 7.0, p = 0.22), surgical wound complications (p = 0.12), or rejection episodes occurring in the first year (p = 0.87). Despite differences in DGF, both groups had excellent renal function at 1 year post-transplant (eGFR 64.1 ± 20.8 vs. 65.8 ± 22.9, p = 0.75). There were no differences in patient (HR 0.58, 95% CI 0.18-1.87, p = 0.26) or kidney allograft survival (HR 0.84, 95% CI 0.23-3.06, p = 0.77). One- and 2-year protocol kidney biopsies were comparable between the groups and showed minimal chronic changes; the early pancreas loss group showed more cv changes at 2 years (p = 0.04). Current data demonstrate good outcomes and excellent kidney allograft function following early pancreas loss.
在胰肾联合（SPK）移植中，早期胰腺移植物丢失与更长的围手术期恢复和降低的肾移植物功能有关。我们评估了早期胰腺移植物失败对 218 例 SPK 患者当代队列移植结局的影响。12.8%（n=28）的受者发生早期胰腺移植物丢失。早期胰腺丢失组发生延迟移植物功能（DGF）的情况更为常见（21.4% vs. 7.4%，p=0.03），但住院时间（中位数 6.5 对 7.0，p=0.22）、手术伤口并发症（p=0.12）或移植后 1 年内发生排斥反应的差异无统计学意义（p=0.87）。尽管 DGF 存在差异，但两组在移植后 1 年时肾功能均良好（eGFR 64.1±20.8 对 65.8±22.9，p=0.75）。患者（HR 0.58，95%CI 0.18-1.87，p=0.26）或肾移植物存活率（HR 0.84，95%CI 0.23-3.06，p=0.77）均无差异。两组的 1 年和 2 年方案肾活检结果相似，显示出最小的慢性变化；早期胰腺丢失组在 2 年时显示出更多的 cv 变化（p=0.04）。目前的数据表明，在早期胰腺丢失后，可获得良好的结果和优异的肾移植物功能。
