根据自身抗体状态和移植前空腹C肽分层的同期胰肾联合移植结果
Simultaneous Pancreas-Kidney Transplant Outcomes Stratified by Autoantibodies Status and Pretransplant Fasting C-peptide.
作者信息
Parajuli Sandesh, Tamburrini Riccardo, Aziz Fahad, Dodin Ban, Astor Brad C, Mandelbrot Didier, Kaufman Dixon, Odorico Jon
机构信息
Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
出版信息
Transplant Direct. 2024 Oct 10;10(11):e1721. doi: 10.1097/TXD.0000000000001721. eCollection 2024 Nov.
BACKGROUNDS
Pancreatic beta cell function and islet autoantibodies classically distinguish types of diabetes (type 1 diabetes mellitus [DM] or type 2 DM). Here, we sought to evaluate simultaneous pancreas-kidney (SPK) transplant outcomes stratified by the presence or absence of beta cell function and autoantibodies.
METHODS
SPK recipients were eligible if pretransplant autoantibodies were measured against insulin, islet cell, or glutamic acid decarboxylase 65-kD isoform. Recipients were categorized as A or A based on the detection of ≥1 autoantibodies. Recipients were similarly categorized on the basis of detectable pretransplant fasting C-peptide of ≥2 ng/mL (β) or <2 ng/mL (β). Thus, recipients were categorized into 4 groups: Aβ, Aβ, Aβ, and Aβ. Outcomes of interest were overall pancreas graft failure (non-death-censored), death-censored pancreas, or kidney graft failure (death-censored pancreas graft failure [DCGF]; kidney DCGF), composite outcomes with any of the 3 outcomes as pancreas DCGF, use of an antidiabetic agent, or hemoglobin A1c >6.5.
RESULTS
One hundred eighty-three SPK recipients were included: Aβ (n = 72), Aβ (n = 42), Aβ (n = 49), and Aβ (n = 20). We did not detect a statistical difference in non-death-censored pancreas graft failure for Aβ recipients compared with other groups: Aβ (adjusted hazard ratio [aHR]: 0.44; 95% confidence interval [CI], 0.14-1.42), Aβ (aHR: 1.02; 95% CI, 0.37-2.85), and Aβ (aHR: 0.67; 95% CI, 0.13-3.33) in adjusted analyses. Similar outcomes were observed for other outcomes.
CONCLUSIONS
In SPK recipients, outcomes were similar among recipients with classic features of type 1 DM and various other types of DM.
背景
胰腺β细胞功能和胰岛自身抗体是区分糖尿病类型（1型糖尿病[DM]或2型DM）的经典指标。在此，我们试图评估根据β细胞功能和自身抗体的有无进行分层的同期胰肾（SPK）移植结局。
方法
如果在移植前检测到针对胰岛素、胰岛细胞或谷氨酸脱羧酶65-kD异构体的自身抗体，则SPK受者符合纳入标准。根据是否检测到≥1种自身抗体，将受者分为A或A。根据移植前空腹C肽检测值≥2 ng/mL（β）或<2 ng/mL（β），对受者进行类似分类。因此，受者被分为4组：Aβ、Aβ、Aβ和Aβ。感兴趣的结局包括总体胰腺移植失败（非死亡截尾）、死亡截尾的胰腺或肾脏移植失败（死亡截尾的胰腺移植失败[DCGF]；肾脏DCGF）、以胰腺DCGF这3种结局中的任何一种作为组成部分的复合结局、使用抗糖尿病药物或糖化血红蛋白>6.5。
结果
纳入了183例SPK受者：Aβ（n = 72）、Aβ（n = 42）、Aβ（n = 49）和Aβ（n = 20）。与其他组相比，我们未检测到Aβ受者在非死亡截尾的胰腺移植失败方面存在统计学差异：在调整分析中，Aβ（调整风险比[aHR]：0.44；95%置信区间[CI]，0.14 - 1.42）、Aβ（aHR：1.02；95% CI，0.37 - 2.85）和Aβ（aHR：0.67；95% CI，0.13 - 3.33）。其他结局也观察到了类似结果。
结论
在SPK受者中，具有1型DM经典特征的受者与其他各种类型DM的受者结局相似。
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