Buckel E, Morales J, Aguiló J, Rosenfeld R, Pefaur J, Zavala C, Herzog C
Departamento de Medicina Clínica Las Condes, Santiago de Chile.
Rev Med Chil. 1996 Jan;124(1):83-8.
We report two insulin dependent diabetic patients with a past history of 21 and 30 years complicated with retinopathy, neuropathy and nephropathy with arterial hypertension and kidney failure. Simultaneous pancreas-kidney transplantation was done 8 and 18 months after starting hemodialysis, performing a double intraperitoneal implant with pancreato-duodeno-vesical anastomosis and contralateral kidney grafting with uretero vesical anastomosis using antireflux techniques. In the second case, a second kidney transplant from the same donor was needed, due to a thrombosis of renal vein. There was one rejection episode in each case but renal or pancreatic function was not impaired. Other observed complications were metabolic acidosis and hyperkalemia due to urine loss of bicarbonate, moderate arterial hypertension and bacterial and fungal infections. There was a graft dysfunction due to the association of vancomycin and cyclosporin. In conclusion, in the two presented patients, simultaneous pancreas-kidney transplantations were successful and they remain free of insulin or dialytic therapy 4 and 9 months after the operation.
我们报告了两名胰岛素依赖型糖尿病患者，他们分别有21年和30年的病史，并发视网膜病变、神经病变和肾病，伴有动脉高血压和肾衰竭。在开始血液透析8个月和18个月后进行了胰肾联合移植，采用胰十二指肠膀胱吻合术进行双腹腔内植入，并使用抗反流技术进行对侧肾移植，输尿管膀胱吻合术。在第二例中，由于肾静脉血栓形成，需要从同一供体进行第二次肾移植。每例均有一次排斥反应，但肾功能或胰腺功能未受损害。观察到的其他并发症包括由于碳酸氢盐尿丢失导致的代谢性酸中毒和高钾血症、中度动脉高血压以及细菌和真菌感染。由于万古霉素和环孢素联合使用导致移植物功能障碍。总之，在这两名患者中，胰肾联合移植均获成功，术后4个月和9个月他们仍无需胰岛素或透析治疗。
