Di Landro D, Koenigsrainer A, Oefner D, Aichberger C, Romagnoli G F, Margreiter R
Department of Nephrology and Dialysis, University Hospital Padova, Italy.
Nephron. 1996;72(4):547-51. doi: 10.1159/000188937.
Compared to the still increasing number of kidney, liver and heart transplants performed worldwide, pancreas transplantation remains a rare occurrence. At our center a pancreas transplant program was began in late 1979. Since then a total of 113 pancreas transplants were performed in 106 patients, 100 of them also received a kidney from the same donor. The first group consisted of 5 patients with immediate duct occlusion (IDO). In the second group (n = 8) the pancreatic juice of the segmental graft was diverted into a Roux-Y loop of jejunum. Because of two fatal technique-associated complications, delayed duct occlusion was introduced and applied in 15 patients. Because of a prolonged hospitalization period due to local complications, the surgical technique was changed again. From 1987, 72 segmental pancreatic transplants with bladder drainage were performed and finally one whole organ with a duodenal segment was transplanted. Immunosuppression consisted of cyclosporine A, azathioprine and prednisolone from 1984 on. Rejection episodes were treated with a high-dose methylprednisolone on 3 consecutive days and steroid-resistant rejections with ATG. The overall patient survival at 6 years was 80%, renal allograft survival 72% and pancreas graft survival 63% for the entire group. In the delayed duct occlusion group, 1-year patient and kidney graft survival of 93% each and 79% for the pancreas was calculated. One-year survival in the most recent and largest group with bladder drainage was 89% for patients, 86% for the kidney and 75% for the pancreas. Excellent metabolic control was achieved in the majority of patients with mean C-peptide levels and HbA1C levels at 6 months of 1.46 pmol/ml and 5.6%, respectively. Successful pancreas transplants with normalization of carbohydrate metabolism seem to have a beneficial effect on secondary complications of diabetes, contributing to the high degree of rehabilitation of these patients.
与全球范围内仍在不断增加的肾、肝和心脏移植数量相比，胰腺移植仍然较为罕见。1979年末，我们中心启动了胰腺移植项目。从那时起，共对106例患者进行了113例胰腺移植，其中100例患者还接受了来自同一供体的肾脏。第一组由5例采用即时导管闭塞（IDO）的患者组成。第二组（n = 8）将节段性移植物的胰液引流至空肠的Roux-Y袢中。由于发生了两例与技术相关的致命并发症，因此引入并对15例患者应用了延迟导管闭塞。由于局部并发症导致住院时间延长，手术技术再次改变。从1987年起，进行了72例采用膀胱引流的节段性胰腺移植，最终移植了1例带十二指肠节段的全器官胰腺。自1984年起，免疫抑制方案包括环孢素A、硫唑嘌呤和泼尼松龙。排斥反应发作时，连续3天给予大剂量甲泼尼龙治疗，对激素抵抗性排斥反应则使用抗胸腺细胞球蛋白治疗。整个组的6年总体患者生存率为80%，肾移植存活率为72%，胰腺移植存活率为63%。在延迟导管闭塞组中，计算得出1年患者和肾移植存活率均为93%，胰腺移植存活率为79%。在最近最大的采用膀胱引流的组中，1年生存率患者为89%，肾脏为86%，胰腺为75%。大多数患者实现了良好的代谢控制，6个月时平均C肽水平和糖化血红蛋白（HbA1C）水平分别为1.46 pmol/ml和5.6%。碳水化合物代谢正常化的成功胰腺移植似乎对糖尿病的继发并发症具有有益影响，有助于这些患者的高度康复。
