Shin Jiyoung, Woo Hye Young, Jo Eun-Ah, Cho Ara, Han Ahram, Ahn Sanghyun, Min Sangil, Ha Jongwon
Division of Vascular Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
Ann Surg Treat Res. 2025 May;108(5):271-278. doi: 10.4174/astr.2025.108.5.271. Epub 2025 Apr 28.
Pancreas transplantation (PT) is a definitive treatment for diabetes mellitus (DM), restoring endogenous insulin secretion and improving glycemic control. Despite its efficacy, PT is less common in South Korea compared to Western nations. This study aims to report the clinical outcomes of PT over 2 decades at a single center, focusing on surgical techniques, complications, and graft survival.
A retrospective analysis of 69 PT recipients at Seoul National University Hospital between January 2002 and December 2023 was conducted. Data on recipient and donor demographics, surgical details, immunosuppressive regimens, and graft outcomes were collected. Graft survival was evaluated using Kaplan-Meier analysis, with subgroup comparisons using the log-rank test. Graft failure was defined as graft removal, PT re-registration, insulin dependence exceeding 0.5 units/kg/day for more than 90 days, or patient death.
Among the 69 recipients, 50 (72.5%) had type 1 DM, and 18 (26.1%) had type 2 DM. Simultaneous pancreas-kidney (SPK) transplantations comprised 84.1% (n = 58), and pancreas-after-kidney (PAK) transplantations accounted for 10.1%. The 1-year and 5-year death-censored pancreas graft survival rates were 92.7% and 89.6%, respectively, with no significant difference between SPK and PAK (P = 0.330). Graft failure occurred in 10 patients, primarily due to pancreatitis and rejection. Donor-related factors, particularly anoxic brain injury, were significantly associated with lower graft survival (P = 0.045).
PT outcomes in this cohort align with international standards, emphasizing the importance of donor selection and tailored immunosuppression. Expanding PT indications to include selective type 2 DM patients could benefit South Korea's PT programs with adequate resource allocation.
胰腺移植（PT）是治疗糖尿病（DM）的一种确定性疗法，可恢复内源性胰岛素分泌并改善血糖控制。尽管其疗效显著，但与西方国家相比，PT在韩国并不常见。本研究旨在报告单一中心20多年来胰腺移植的临床结果，重点关注手术技术、并发症和移植物存活情况。
对2002年1月至2023年12月期间首尔国立大学医院的69例胰腺移植受者进行回顾性分析。收集了受者和供者的人口统计学数据、手术细节、免疫抑制方案和移植物结果。采用Kaplan-Meier分析评估移植物存活情况，使用对数秩检验进行亚组比较。移植物失败定义为移植物切除﹑再次进行胰腺移植登记﹑胰岛素依赖超过0.5单位/（千克·天）持续超过90天或患者死亡。
在69例受者中，50例（72.5%）患有1型糖尿病，18例（26.1%）患有2型糖尿病。胰肾联合移植（SPK）占84.1%（n = 58），肾后胰腺移植（PAK）占10.1%。1年和5年校正死亡后的胰腺移植物存活率分别为92.7%和89.6%，SPK和PAK之间无显著差异（P = 0.330）。10例患者发生移植物失败，主要原因是胰腺炎和排斥反应。供者相关因素，尤其是缺氧性脑损伤，与较低的移植物存活率显著相关（P = 0.045）。
该队列中的胰腺移植结果符合国际标准，强调了供者选择和个性化免疫抑制的重要性。将胰腺移植适应证扩大到包括选择性2型糖尿病患者，在有足够资源分配的情况下可能会使韩国的胰腺移植项目受益。
