Fundación Clínica Abood Shaio, Universidad de Antioquia, Medellín, Colombia.
Digestive Diseases and Transplant Functional Unit, Hospital San Vicente Fundación, Rionegro, Colombia.
Biomed Res Int. 2023 Jun 15;2023:2734072. doi: 10.1155/2023/2734072. eCollection 2023.
Simultaneous pancreas-kidney transplantation (SPKT) is a complex and demanding procedure with a considerable risk of morbidity and mortality. Advances in surgical techniques and organ preservation have introduced changes in care protocols. Two cohorts of patients receiving SPKT with two different protocols were compared to determine overall survival and pancreatic and renal graft failure-free survival.
This retrospective observational study was conducted in two cohorts of SPKT recipient patients that underwent surgery between 2001 and 2021. Outcomes were compared in transplant patients between 2001 and 2011 (cohort 1; initial protocol) and 2012-2021 (cohort 2; improved protocol). In addition to the temporality, the cohorts were defined by a protocolization of technical aspects and medical management in cohort 2 (improved protocol), compared to a wide variability in the procedures carried out in cohort 1 (initial protocol). Overall survival and pancreatic and renal graft failure-free survival were the primary outcomes. These outcomes were determined using Kaplan-Meier survival analysis and the log-rank test.
Fifty-five SPKT were performed during the study period: 32 in cohort 1 and 23 in cohort 2. In the survival analysis, an average of 2546 days (95% CI: 1902-3190) was found in cohort 1, while in cohort 2, it was 2540 days (95% CI: 2100-3204) ( > 0.05). Pancreatic graft failure-free survival had an average of 1705 days (95% CI: 1037-2373) in cohort 1, lower than the average in cohort 2 (2337 days; 95% CI: 1887-2788) ( = 0.016). Similarly, renal graft failure-free survival had an average of 2167 days (95% CI: 1485-2849) in cohort 1, lower than the average in cohort 2 (2583 days; 95% CI: 2159-3006) ( = 0.017).
This analysis indicates that pancreatic and renal graft failure-free survival associated with SPKT decreased significantly in cohort 2, with results related to improvements in the treatment protocol implemented in that cohort.
胰肾联合移植（SPKT）是一种复杂且要求高的手术，具有相当高的发病率和死亡率。手术技术和器官保存方面的进步已经改变了护理方案。本研究比较了两组接受不同方案的 SPKT 患者，以确定总体生存率以及胰腺和肾脏移植物无失败生存率。
本回顾性观察性研究纳入了 2001 年至 2021 年间接受 SPKT 的两组患者。将 2001 年至 2011 年（队列 1；初始方案）和 2012 年至 2021 年（队列 2；改良方案）接受移植的患者进行比较，以确定总体生存率以及胰腺和肾脏移植物无失败生存率。除了时间因素外，队列 1（初始方案）的手术程序差异较大，而队列 2（改良方案）则在技术方面和医疗管理方面进行了方案化定义。总体生存率以及胰腺和肾脏移植物无失败生存率是主要结局。这些结果通过 Kaplan-Meier 生存分析和对数秩检验来确定。
在研究期间进行了 55 例 SPKT：队列 1 中进行了 32 例，队列 2 中进行了 23 例。在生存分析中，队列 1 的平均随访时间为 2546 天（95%CI：1902-3190），而队列 2 的平均随访时间为 2540 天（95%CI：2100-3204）（>0.05）。队列 1 的胰腺移植物无失败生存率为 1705 天（95%CI：1037-2373），低于队列 2 的 2337 天（95%CI：1887-2788）（=0.016）。同样，队列 1 的肾脏移植物无失败生存率为 2167 天（95%CI：1485-2849），低于队列 2 的 2583 天（95%CI：2159-3006）（=0.017）。
本分析表明，与 SPKT 相关的胰腺和肾脏移植物无失败生存率在队列 2 中显著下降，这与该队列中实施的治疗方案的改进有关。
