Gross C R, Limwattananon C, Matthees B J
College of Pharmacy, University of Minnesota, Minneapolis 55455, USA.
Clin Transplant. 1998 Aug;12(4):351-61.
For persons with diabetes and end stage renal disease, successful combined or sequential pancreas/kidney transplant is an attractive therapeutic alternative to insulin and dialysis. There is considerable controversy regarding pancreas transplantation (p Tx), however, as some recent reviews have concluded, p Tx results in at most only modest reductions in secondary complications and has increased morbidity and costs compared with kidney transplant alone. While the impact on patients' quality of life (QOL) is a major consideration for p Tx, the literature on this topic has not been carefully considered. The purpose of this review is to evaluate studies of QOL after p Tx and identify well-validated findings. Comparative cross-sectional and longitudinal studies have shown that the QOL outcomes of p Tx recipients who achieve insulin-independence are better than those of candidates or of recipients with pancreas graft loss. More positive health perceptions, improved social interaction and increased vitality/energy are significantly associated with successful p Tx. Researchers have found few areas where the QOL benefits of p Tx significantly exceed or differ from those that occur with kidney transplant alone. A consistent finding across studies is that p Tx improves patient perceptions about diabetes-specific issues such as satisfaction with diet flexibility and health management, while kidney transplant does not. Future studies should attempt to accrue sufficient sample sizes to permit statistical adjustment for selection biases; follow patients for several years to permit differences in rates of progression of secondary complications to impact QOL; and use current graft loss and morbidity statistics to estimate any added risks of p Tx over kidney-only transplant. It is still an open question as to whether or not there are sufficient QOL benefits from p Tx long-term to out-weigh added risks, and this needs to remain an active area of investigation.
对于患有糖尿病和终末期肾病的患者而言，成功进行胰腺/肾脏联合移植或序贯移植是胰岛素治疗和透析之外颇具吸引力的治疗选择。然而，胰腺移植（p Tx）存在相当大的争议，正如近期一些综述所指出的，与单纯肾脏移植相比，p Tx最多只能使继发性并发症略有减少，且会增加发病率和成本。虽然对患者生活质量（QOL）的影响是p Tx的一个主要考量因素，但关于这一主题的文献尚未得到仔细研究。本综述的目的是评估p Tx术后生活质量的研究，并确定经过充分验证的研究结果。比较性横断面研究和纵向研究表明，实现胰岛素自主的p Tx受者的生活质量结果优于候选者或胰腺移植失败的受者。更积极的健康认知、改善的社交互动以及增强的活力/精力与成功的p Tx显著相关。研究人员发现，在生活质量益处方面，p Tx显著超过或不同于单纯肾脏移植的领域很少。各项研究的一个一致发现是，p Tx改善了患者对糖尿病特定问题的认知，如对饮食灵活性和健康管理的满意度，而肾脏移植则没有。未来的研究应努力积累足够大的样本量，以便对选择偏倚进行统计调整；对患者进行数年随访，以了解继发性并发症进展速度的差异对生活质量的影响；并使用当前的移植失败和发病率统计数据来估计p Tx相较于单纯肾脏移植所增加的任何风险。p Tx长期而言在生活质量方面的益处是否足以抵消额外风险仍是一个悬而未决 的问题，这仍需作为一个活跃的研究领域。
