Hau Hans-Michael, Jahn Nora, Rademacher Sebastian, Sucher Elisabeth, Babel Jonas, Mehdorn Matthias, Lederer Andri, Seehofer Daniel, Scheuermann Uwe, Sucher Robert
Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany.
Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany.
J Clin Med. 2021 Apr 12;10(8):1632. doi: 10.3390/jcm10081632.
BACKGROUND/OBJECTIVES: The sequence of graft implantation in simultaneous pancreas-kidney transplantation (SPKT) warrants additional study and more targeted focus, since little is known about the short- and long-term effects on the outcome and graft survival after transplantation.
103 patients receiving SPKT in our department between 1999 and 2015 were included in the study. Patients were divided according to the sequence of graft implantation into pancreas-first (PF, = 61) and kidney-first (KF, = 42) groups. Clinicopathological characteristics, outcome and survival were reviewed retrospectively.
Donor and recipient characteristics were similar. Rates of post-operative complications and graft dysfunction were significantly higher in the PF group compared with the KF group (episodes of acute rejection within the first year after SPKT: 11 (18%) versus 2 (4.8%); graft pancreatitis: 18 (18%) versus 2 (4.8%), = 0.04; vascular thrombosis of the pancreas: 9 (14.8%) versus 1 (2.4%), = 0.03; and delayed graft function of the kidney: 12 (19.6%) versus 2 (4.8%), = 0.019). The three-month pancreas graft survival was significantly higher in the KF group (PF: 77% versus KF: 92.1%; = 0.037). No significant difference was observed in pancreas graft survival five years after transplantation (PF: 71.6% versus KF: 84.8%; = 0.104). Kidney graft survival was similar between the two groups. Multivariate analysis revealed order of graft implantation as an independent prognostic factor for graft survival three months after SPKT (HR 2.6, 1.3-17.1, = 0.026) and five years (HR 3.7, 2.1-23.4, = 0.040).
Our data indicates that implantation of the pancreas prior to the kidney during SPKT has an influence especially on the early-post-operative outcome and survival rate of pancreas grafts.
背景/目的：在同期胰肾联合移植（SPKT）中，移植物植入顺序值得进一步研究并给予更有针对性的关注，因为对于移植后短期和长期的预后及移植物存活情况了解甚少。
本研究纳入了1999年至2015年间在我科接受SPKT的103例患者。根据移植物植入顺序将患者分为胰先行组（PF，n = 61）和肾先行组（KF，n = 42）。对临床病理特征、预后及存活情况进行回顾性分析。
供体和受体特征相似。与KF组相比，PF组术后并发症发生率和移植物功能障碍发生率显著更高（SPKT术后第一年急性排斥发作次数：11次（18%）对2次（4.8%）；移植胰胰腺炎：18次（18%）对2次（4.8%），P = 0.04；胰腺血管血栓形成：9次（14.8%）对1次（2.4%），P = 0.03；肾移植功能延迟：12次（19.6%）对2次（4.8%），P = 0.019）。KF组三个月的胰腺移植物存活率显著更高（PF组：77%对KF组：92.1%；P = 0.037）。移植后五年胰腺移植物存活率无显著差异（PF组：71.6%对KF组：84.8%；P = 0.104）。两组间肾移植物存活率相似。多因素分析显示，移植物植入顺序是SPKT术后三个月（HR 2.6，1.3 - 17.1，P = 0.026）和五年（HR 3.7，2.1 - 23.4，P = 0.040）移植物存活的独立预后因素。
我们的数据表明，在SPKT中胰先行于肾植入尤其会影响术后早期胰腺移植物的预后和存活率。
