Department of Surgery, Division of Abdominal Transplant Surgery, Indiana University School of Medicine, USA.
Clin Transplant. 2021 Jun;35(6):e14307. doi: 10.1111/ctr.14307. Epub 2021 Apr 10.
Early pancreas allograft failure most commonly results from vascular thrombosis. Immediate surgical intervention may permit pancreas allograft salvage, typically requiring thrombectomy. In cases of partial allograft necrosis secondary to splenic arterial thrombosis, distal allograft pancreatectomy may allow salvage of at least half of the pancreas allograft with retention of function. We retrospectively reviewed four cases of simultaneous pancreas and kidney recipients who required distal allograft pancreatectomy for splenic artery thrombosis with necrosis of the distal pancreas. Three of the four maintained long-term allograft function with euglycemia independent of insulin at six months to six years of follow-up, and all patients continue to maintain normal renal allograft function. Early diagnosis and early intervention are essential in order to salvage the pancreas allograft in the case of thrombosis. Distal allograft pancreatectomy can be performed safely and result in excellent long-term outcomes in select patients.
早期胰腺移植失败最常见的原因是血管血栓形成。及时的外科干预可能允许胰腺移植的挽救，通常需要血栓切除术。在由于脾动脉血栓形成导致部分胰腺移植物坏死的情况下，远端胰腺切除术可能允许挽救至少一半的胰腺移植物并保留其功能。我们回顾性分析了 4 例同时接受胰腺和肾脏移植的患者，这些患者因脾动脉血栓形成导致远端胰腺坏死而需要进行远端胰腺切除术。这 4 例中有 3 例在 6 个月至 6 年的随访中维持了长期的胰腺移植物功能，并且血糖正常，无需胰岛素，所有患者均继续保持正常的肾脏移植物功能。为了挽救血栓形成情况下的胰腺移植物，早期诊断和早期干预至关重要。在选择的患者中，远端胰腺切除术可以安全进行，并获得极好的长期结果。
