Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Anette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas.
Am J Transplant. 2021 Aug;21(8):2810-2823. doi: 10.1111/ajt.16462. Epub 2021 Jan 15.
Studies have found similar outcomes of Simultaneous Pancreas-Kidney transplantation (SPKT) in patients with Type 2 (T2D) and Type 1 diabetes (T1D). However, there are scarce data evaluating the association of recipient factors such as age, BMI, or pretransplant insulin requirements with outcomes, thus the criteria for the optimal recipient selection remains unclear. In this study, 284 T1D and 39 T2D patients, who underwent SPKT between 2006 and 2017 with 1 year of follow-up at minimum, were assessed for potential relationship of pretransplant BMI and insulin requirements with posttransplant diabetes and pancreatic graft failure. Kaplan-Meier analysis showed similar rates of freedom from posttransplant diabetes (94.7% T2D vs. 92.3% T1D at 1 yr, and 88.1% T2D vs. 81.1% T1D at 5 yrs) and graft survival (89.7% T2D vs. 90.4% T1D at 1 yr, and 89.7% T2D vs. 81.2% T1D at 5 yrs). There was no significant association between BMI or pretransplant insulin requirements with posttransplant diabetes occurrence in either T1D (p = .10, .43, respectively) or T2D (p = .12, .63) patients in the cohort; or with graft failure (T1D: p = .40, .09; T2D: p = .71, .28). These observations suggest a less restricted approach to selective use of SPKT in patients with T2D.
研究发现，2 型糖尿病（T2D）和 1 型糖尿病（T1D）患者接受胰肾联合移植（SPKT）的结果相似。然而，评估受体因素（如年龄、BMI 或移植前胰岛素需求）与结果之间的关联的数据很少，因此，最佳受体选择标准仍不清楚。本研究评估了 2006 年至 2017 年间接受 SPKT 的 284 例 T1D 和 39 例 T2D 患者，这些患者至少随访 1 年，评估移植前 BMI 和胰岛素需求与移植后糖尿病和胰腺移植物失功的潜在关系。Kaplan-Meier 分析显示，移植后糖尿病无复发率相似（T2D 为 94.7%，T1D 为 92.3%，1 年；T2D 为 88.1%，T1D 为 81.1%，5 年）和移植物存活率（T2D 为 89.7%，T1D 为 90.4%，1 年；T2D 为 89.7%，T1D 为 81.2%，5 年）。在队列中，T1D（p=0.10，0.43）或 T2D（p=0.12，0.63）患者中，BMI 或移植前胰岛素需求与移植后糖尿病的发生均无显著相关性；或与移植物失功（T1D：p=0.40，0.09；T2D：p=0.71，0.28）无显著相关性。这些观察结果表明，对于 T2D 患者，SPKT 的选择性使用可以采取较为宽松的方法。
