Sollinger H W, Odorico J S, Knechtle S J, D'Alessandro A M, Kalayoglu M, Pirsch J D
Department of Surgery, University of Wisconsin School of Medicine, Madison 53792-7375, USA.
Ann Surg. 1998 Sep;228(3):284-96. doi: 10.1097/00000658-199809000-00002.
From December 1985 to October 1997, 500 simultaneous pancreas-kidney transplants (SPKs) were performed at the University of Wisconsin. Bladder drainage (BD) was used in 388 and enteric drainage (ED) in 112. All pancreas transplants were preserved in UW solution.
Patient survival at 1, 5, and 10 years was 96.4%, 88.6%, and 76.3%; kidney function, 88.6%, 80.3%, and 66.6%; and pancreas function, 87.5%, 78.1%, and 67.2%. Thrombosis of the pancreas occurred in three to four (0.6% to 0.8%) and primary nonfunction in one (0.2%). There was a 4.2% acute tubular necrosis rate for the kidney. Conversion from BD to ED was required in 24% of cases. Primary indications for enteric conversion (EC) were leak (14%), urethritis and extravasation (7%), and chronic hematuria (3%). No graft was lost as a result of EC. There was no difference in 1-year graft survival between ED and BD. Leading causes of pancreas loss were rejection in 45 patients and death with a functioning graft in 27 patients. Since June 1995, mycophenolate mofetil was used for immunosuppression (n = 109). One-year survival rates with mycophenolate mofetil are patient, 98.1 %; kidney, 94.2%; and pancreas, 93.1%. Steroid-resistant rejections decreased from 48% to 15%.
This series represents the world's largest experience with SPK, including the longest follow-up for BD pancreatic transplants. Ten-year graft survival rates exceed those of all other transplants, with the exception of HLA-identical living-related grafts. This series confirms that SPK is a highly successful procedure for selected diabetic patients with renal failure.
1985年12月至1997年10月，威斯康星大学共进行了500例同期胰肾联合移植（SPK）手术。其中388例采用膀胱引流（BD），112例采用肠道引流（ED）。所有胰腺移植均采用UW液保存。
1年、5年和10年的患者生存率分别为96.4%、88.6%和76.3%；肾功能分别为88.6%、80.3%和66.6%；胰腺功能分别为87.5%、78.1%和67.2%。胰腺血栓形成3至4例（0.6%至0.8%），原发性无功能1例（0.2%）。肾脏急性肾小管坏死率为4.2%。24%的病例需要从BD转换为ED。肠道转换（EC）的主要指征为渗漏（14%）、尿道炎和外渗（7%）以及慢性血尿（3%）。没有因EC导致移植物丢失。ED和BD的1年移植物生存率无差异。胰腺丢失的主要原因是45例患者发生排斥反应，27例患者移植肾功能正常时死亡。自1995年6月起，霉酚酸酯用于免疫抑制（n = 109）。使用霉酚酸酯的1年生存率为：患者98.1%；肾脏94.2%；胰腺93.1%。耐类固醇排斥反应从48%降至15%。
本系列代表了世界上最大规模的SPK经验，包括对BD胰腺移植最长时间的随访。除HLA匹配的亲属活体移植外，10年移植物生存率超过所有其他移植。本系列证实，SPK对于选定的糖尿病肾衰竭患者是一种非常成功的手术。
