Dias Bruno Fraga, Marques Roberto Calças, Cardoso Catarina, Faria Vitória, Domingues Patrícia, Ribeiro Catarina, Silvano José, Silva Donzília, Pedroso Sofia, Almeida Manuela, Malheiro Jorge, Martins La Salete
Nephrology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal.
Nephrology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal.
Clin Transplant. 2024 May;38(5):e15339. doi: 10.1111/ctr.15339.
Simultaneous pancreas-kidney transplantation (SPKT) is the best treatment for selected individuals with type 1 diabetes mellitus and end-stage renal disease. Despite advances in surgical techniques, donor and recipient selection, and immunosuppressive therapies, SPKT remains a complex procedure with associated surgical complications and adverse consequences. We conducted a retrospective study that included 263 SPKT procedures performed between May 2000, and December 2022. A total of 65 patients (25%) required at least one relaparotomy, resulting in an all-cause relaparotomy rate of 2.04 events per 100 in-hospital days. Lower donor body mass index was identified as an independent factor associated with reoperation (OR .815; 95% CI: .725-.917, p = .001). Technical failure (TF) occurred in 9.9% of cases, primarily attributed to pancreas graft thrombosis, intra-abdominal infections, bleeding, and anastomotic leaks. Independent predictors of TF at 90 days included donor age above 36 years (HR 2.513; 95% CI 1.162-5.434), previous peritoneal dialysis (HR 2.503; 95% CI 1.149-5.451), and specific pancreas graft reinterventions. The findings highlight the importance of carefully considering donor and recipient factors in SPKT. The incidence of TF in our study population aligns with the recent series. Continuous efforts should focus on identifying and mitigating potential risk factors to enhance SPKT outcomes, thereby reducing post-transplant complications.
胰肾联合移植（SPKT）是治疗特定1型糖尿病合并终末期肾病患者的最佳方法。尽管手术技术、供体和受体选择以及免疫抑制疗法取得了进展，但SPKT仍然是一个复杂的手术，伴有相关的手术并发症和不良后果。我们进行了一项回顾性研究，纳入了2000年5月至2022年12月期间进行的263例SPKT手术。共有65例患者（25%）需要至少一次再次剖腹手术，全因再次剖腹手术率为每100个住院日2.04次。较低的供体体重指数被确定为与再次手术相关的独立因素（OR = 0.815；95% CI：0.725 - 0.917，p = 0.001）。技术失败（TF）发生在9.9%的病例中，主要归因于胰腺移植血栓形成、腹腔内感染、出血和吻合口漏。90天时TF的独立预测因素包括供体年龄超过36岁（HR = 2.513；95% CI 1.162 - 5.434）、既往腹膜透析（HR = 2.503；95% CI 1.149 - 5.451）以及特定的胰腺移植再次干预。这些发现凸显了在SPKT中仔细考虑供体和受体因素的重要性。我们研究人群中的TF发生率与近期系列研究一致。应持续努力识别和减轻潜在风险因素，以改善SPKT结果，从而减少移植后并发症。
