Choksi Harsham, Pleass Henry, Robertson Paul, Au Eric, Rogers Natasha
Faculty of Medicine and Health, University of Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Kidney Injury Group, Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, NSW, Australia.
Transplantation. 2025 Jul 1;109(7):1222-1229. doi: 10.1097/TP.0000000000005334. Epub 2025 Jan 23.
Simultaneous pancreas-kidney (SPK) transplantation is an effective treatment option for type 1 diabetes mellitus and concurrent end-stage kidney disease. However, the diabetogenic effects of immunosuppression can counteract the beneficial effects of sustained normoglycemia. Long-term metabolic trends that reflect cardiovascular risk are reported poorly in the literature.
A total of 500 patients with type 1 diabetes mellitus receiving SPK transplants at a single center with at least 2-y follow-up were evaluated retrospectively. Metabolic parameters and allograft function were followed longitudinally, including patient and allograft survival, body mass index (BMI), lipid profile, quantitative insulin sensitivity check index, estimated glomerular filtration rate, and urinary albumin-creatinine ratio up to 10 y posttransplant.
Patient survival at 1, 5, and 10 y was 97%, 92%, and 87%, and overall death-censored graft survival was 87%, 84%, and 80%, respectively. Survival remained unchanged when stratified by BMI. Compared with pretransplant measurements, BMI significantly increased at 1, 3, and 5 y posttransplant. Total cholesterol, triglycerides, and low-density lipoprotein cholesterol decreased at 10 y posttransplant, with significantly increased high-density lipoprotein cholesterol at 5 y posttransplant. Insulin sensitivity improved significantly at 10 y posttransplant but did not normalize. Urinary albumin-creatinine ratio decreased by 3 y posttransplant but increased significantly between 3 and 10 y posttransplant, although the estimated glomerular filtration rate was unchanged during this time.
SPK transplantation is associated with excellent patient and graft survival. Significant long-term weight gain occurs despite improving lipid profiles and insulin sensitivity posttransplant. These data potentially reflect an overall cardiovascular burden that should be addressed in this population.
胰肾联合移植（SPK）是1型糖尿病合并终末期肾病的一种有效治疗选择。然而，免疫抑制的致糖尿病作用可能会抵消持续正常血糖的有益效果。关于反映心血管风险的长期代谢趋势，文献报道较少。
对在单一中心接受SPK移植且至少随访2年的500例1型糖尿病患者进行回顾性评估。纵向跟踪代谢参数和移植物功能，包括患者和移植物存活率、体重指数（BMI）、血脂谱、定量胰岛素敏感性检查指数、估计肾小球滤过率以及移植后长达10年的尿白蛋白肌酐比。
1年、5年和10年时患者存活率分别为97%、92%和87%，总体死亡审查后的移植物存活率分别为87%、84%和80%。按BMI分层时存活率保持不变。与移植前测量值相比，移植后1年、3年和5年BMI显著增加。移植后10年总胆固醇、甘油三酯和低密度脂蛋白胆固醇降低，移植后5年高密度脂蛋白胆固醇显著增加。移植后10年胰岛素敏感性显著改善但未恢复正常。移植后3年尿白蛋白肌酐比下降，但在移植后3年至10年之间显著增加，尽管在此期间估计肾小球滤过率未变。
SPK移植与出色的患者和移植物存活率相关。尽管移植后血脂谱和胰岛素敏感性有所改善，但仍出现显著的长期体重增加。这些数据可能反映了该人群应解决的总体心血管负担。
