Todo S, Tzakis A, Abu-Elmagd K, Reyes J, Furukawa H, Nour B, Fung J, Demetris A, Starzl T E
Pittsburgh Transplantation Institute, University of Pittsburgh Medical Center, Pennsylvania 15213.
Transplantation. 1995 Jan 27;59(2):234-40. doi: 10.1097/00007890-199501270-00015.
Under FK506-based immunosuppression, 13 abdominal multivisceral transplantations were performed in 6 children and 7 adults. Of the 13 recipients, 7 (53.8%) are alive and well with functioning grafts after 9 to 31 months. Six recipients died: three from PTLD, one from rejection, one from sepsis, and one from respiratory failure. In addition to rejection, postoperative complications occurring in more than isolated cases included PTLD (n = 6), abdominal abscess formation (n = 5), pancreatitis (n = 3), and ampullary dysfunction (n = 2). In addition, infection by enteric microorganisms was common during the early postoperative period. Currently, all 7 survivors are on an oral diet and have normal liver function. Two recipients (one insulin-dependent) require antidiabetes treatment, in one case following distal pancreatectomy and in the other after two episodes of pancreatic rejection. Thus, abdominal multivisceral transplantation is a difficult but feasible operation that demands complex and prolonged posttransplantation management. It is not yet ready for application and awaits a better strategy of immune modulation.
在基于FK506的免疫抑制治疗下，对6名儿童和7名成人进行了13例腹部多脏器移植手术。在这13名受者中，7例（53.8%）在9至31个月后存活且移植器官功能良好。6名受者死亡：3例死于移植后淋巴细胞增生性疾病（PTLD），1例死于排斥反应，1例死于败血症，1例死于呼吸衰竭。除排斥反应外，发生频率超过个别病例的术后并发症包括PTLD（n = 6）、腹部脓肿形成（n = 5）、胰腺炎（n = 3）和壶腹功能障碍（n = 2）。此外，术后早期肠道微生物感染很常见。目前，所有7名幸存者均经口进食且肝功能正常。两名受者（1例为胰岛素依赖型）需要抗糖尿病治疗，1例在远端胰腺切除术后，另1例在经历两次胰腺排斥反应后。因此，腹部多脏器移植是一项困难但可行的手术，需要复杂且长期的移植后管理。它尚未准备好应用，有待更好的免疫调节策略。
