袖状胃切除术使严重肥胖受者能够同时进行胰腺和肾脏移植。
Sleeve gastrectomy enables simultaneous pancreas and kidney transplantation in severely obese recipients.
机构信息
Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
Department of Nephrology, University Hospital Zurich, Zurich, Switzerland.
出版信息
Clin Transplant. 2021 Mar;35(3):e14197. doi: 10.1111/ctr.14197. Epub 2020 Dec 29.
BACKGROUND
Obesity adversely affects wait-listing and precludes patients with concomitant end-stage renal disease and type 1 diabetes mellitus from getting a simultaneous pancreas and kidney transplantation (SPK).
OBJECTIVE
To analyze safety and efficacy of laparoscopic sleeve gastrectomy (LSG) before SPK in severely obese type I diabetics.
METHODS
We assessed weight curve, complications, and graft function of three patients who underwent LSG before SPK.
RESULTS
LSG was uneventful in all patients. Body mass index dropped from 38.4 (range 35.7 - 39.9) before LSG to 28.5 (26.8 - 30.9) until SPK, with a mean loss of 25.8% (22.4 - 32.3). Interval between LSG and SPK was 364.3 (173 - 587) days. Pancreas and kidney graft function was excellent, with 100% insulin-free and dialysis-free survival over a mean follow-up of 3.6 (2.9 - 4.5) years. A1C dropped from 7% (6.3 - 8.2) before LSG to 4.9% (4.7 - 5.3) and 4.8% (4.5 - 5.1) 1 and 2 years after SPK, respectively.
CONCLUSION
LSG before SPK is safe and effective to enable severely obese type I diabetics to receive a lifesaving transplant. This is the first study analyzing the role of bariatric surgery before simultaneous pancreas and kidney transplantation.
背景
肥胖对等候名单有不利影响，并使同时患有终末期肾病和 1 型糖尿病的患者无法同时进行胰腺和肾脏移植（SPK）。
目的
分析腹腔镜袖状胃切除术（LSG）在严重肥胖 1 型糖尿病患者 SPK 前的安全性和有效性。
方法
我们评估了 3 例接受 SPK 前 LSG 的患者的体重曲线、并发症和移植物功能。
结果
所有患者的 LSG 均无并发症。体重指数从 LSG 前的 38.4（范围 35.7-39.9）降至 SPK 时的 28.5（26.8-30.9），平均下降 25.8%（22.4-32.3）。LSG 和 SPK 之间的间隔为 364.3（173-587）天。胰腺和肾脏移植物功能良好，胰岛素和透析均无需 100%存活，平均随访 3.6（2.9-4.5）年后。A1C 从 LSG 前的 7%（6.3-8.2）降至 SPK 后 1 年的 4.9%（4.7-5.3）和 2 年的 4.8%（4.5-5.1）。
结论
SPK 前的 LSG 安全有效，可使严重肥胖的 1 型糖尿病患者接受挽救生命的移植。这是第一项分析减肥手术在胰腺和肾脏同时移植前作用的研究。
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