Sollinger H W, Ploeg R J, Eckhoff D E, Stegall M D, Isaacs R, Pirsch J D, D'Alessandro A M, Knechtle S J, Kalayoglu M, Belzer F O
Department of Surgery, University of Wisconsin School of Medicine, Madison.
Surgery. 1993 Oct;114(4):736-43; discussion 743-4.
Since 1982, 288 pancreas transplantations have been performed at the University of Wisconsin. This report reviews our experience with 200 consecutive simultaneous pancreas-kidney (SPK) transplantations during a 7-year period.
Two hundred consecutive SPK transplantations were performed between December 1985 to October 1992. Immediate posttransplant function and surgical and infectious complications were evaluated. Frequency of rejection episodes were analyzed, as was 5-year patient and graft survival.
All but four pancreas transplants functioned immediately after transplantation. Three pancreas transplants failed because of thrombosis and one from primary nonfunction. Five-year patient survival was 90.2%, kidney survival 80.3%, and pancreas survival 78.6%. There were 54 surgical complications. Fifteen patients have died since 1985. The most frequent cause of death was infection (three patients). A total of 678 infectious episodes were recorded. Urinary tract infection (n = 344) was the most frequent type of infection. Enteric conversion was necessary in 35 patients, with the most frequent indication being a leak of the duodenal segment.
We concluded from this series that SPK transplantation is associated with higher cost and morbidity as compared with kidney transplantation alone. However, excellent long-term survival in combination with the clearly demonstrated benefits for secondary diabetic complications indicate that SPK transplantation is the procedure of choice for carefully selected patients with diabetes.
自1982年以来，威斯康星大学已进行了288例胰腺移植手术。本报告回顾了我们在7年期间连续进行的200例同期胰肾联合移植（SPK）的经验。
在1985年12月至1992年10月期间连续进行了200例SPK移植手术。评估了移植后的即时功能以及手术和感染并发症。分析了排斥反应的发生频率以及患者和移植物的5年生存率。
除4例胰腺移植外，其余所有移植术后均立即发挥功能。3例胰腺移植因血栓形成失败，1例因原发性无功能失败。患者5年生存率为90.2%，肾脏生存率为80.3%，胰腺生存率为78.6%。发生了54例手术并发症。自1985年以来有15例患者死亡。最常见的死亡原因是感染（3例患者）。共记录了678次感染发作。尿路感染（n = 344）是最常见的感染类型。35例患者需要进行肠道改道，最常见的指征是十二指肠段渗漏。
我们从本系列研究得出结论，与单纯肾移植相比，SPK移植的成本和发病率更高。然而，出色的长期生存率以及对继发性糖尿病并发症的明显益处表明，SPK移植是精心挑选的糖尿病患者的首选治疗方法。
