Pirsch J D, Odorico J S, D'Alessandro A M, Knechtle S J, Becker B N, Sollinger H W
Department of Medicine, University of Wisconsin Medical School, Madison 53792, USA.
Transplantation. 1998 Dec 27;66(12):1746-50. doi: 10.1097/00007890-199812270-00031.
Although bladder drainage of the pancreas remains the most common site for drainage of exocrine secretions, enteric drainage is becoming more common in the United States. The most common cause of morbidity after pancreas transplantation is infection, particularly recurrent urinary tract infection.
We examined the incidence of infectious complications for enteric-drained (ED) versus bladder-drained (BD) simultaneous pancreas-kidney transplants (PTx) to determine the incidence of post-transplant infection. The patient cohort included simultaneous pancreas-kidney PTx recipients from June 1995 through August 1997 using a similar induction protocol with antithymocyte globulin, mycophenolate mofetil, prednisone, and Neoral. During this time period, 48 BD PTx and 78 ED PTx were performed. Demographic data including age of transplant, gender, race, and duration of initial hospital stay were similar. However, mean follow-up for the BD PTx was 1.9 years vs. 0.9 years for ED PTx. Rejection, infection, and graft and patient survival rates were estimated by the method of Kaplan and Meier.
For the entire cohort, 1-year patient survival was 98%, kidney survival 94%, and pancreas survival 93%. There was no difference in survival between ED or BD PTx. At 6 months, kidney transplant rejection had occurred in 38% of BD PTx vs. 30% of ED PTx. Steroid resistant rejection was similar (BD 19%, ED 17%). Postoperative pancreatic leak occurred in 12% BD PTx and 5% ED PTx (P=0.06). There was no significant difference in time to first infection or first abdominal infection between groups. Opportunistic infections were much less likely to occur in ED recipients by 1 year (12% vs. 31%, P=0.002). Both cytomegalovirus infection rates (BD 21% vs. ED 8%, P=0.04) and fungal infection rates (BD 17% vs. ED 4%, P=0.04) were lower in ED PTx. The rate of first urinary tract infection was dramatically decreased with ED. At 1 year, only 20% of ED PTx developed a urinary tract infection vs. 63% of BD PTx (P=0.0001).
Enteric drainage of the pancreas is more physiologic, has similar results to bladder drainage, but has less infectious complications, particularly urinary tract infections.
尽管胰腺的膀胱引流仍是外分泌液引流最常见的部位，但在美国，肠道引流正变得越来越普遍。胰腺移植后发病的最常见原因是感染，尤其是复发性尿路感染。
我们检查了肠道引流（ED）与膀胱引流（BD）的同期胰肾联合移植（PTx）的感染并发症发生率，以确定移植后感染的发生率。患者队列包括1995年6月至1997年8月接受同期胰肾联合移植的受者，使用了类似的抗胸腺细胞球蛋白、霉酚酸酯、泼尼松和新山地明诱导方案。在此期间，进行了48例BD PTx和78例ED PTx。人口统计学数据包括移植年龄、性别、种族和初次住院时间相似。然而，BD PTx的平均随访时间为1.9年，而ED PTx为0.9年。采用Kaplan-Meier方法估计排斥反应、感染以及移植物和患者的生存率。
对于整个队列，1年患者生存率为98%，肾脏生存率为94%，胰腺生存率为93%。ED或BD PTx之间的生存率没有差异。6个月时，38%的BD PTx发生了肾移植排斥反应，而ED PTx为30%。激素抵抗性排斥反应相似（BD为19%，ED为17%）。术后胰漏发生率在BD PTx中为12%，在ED PTx中为5%（P = 0.06）。两组之间首次感染或首次腹部感染的时间没有显著差异。到1年时，ED受者发生机会性感染的可能性要小得多（12%对31%，P = 0.002）。ED PTx中的巨细胞病毒感染率（BD为21%，ED为8%，P = 0.04）和真菌感染率（BD为17%，ED为4%，P = 0.04）均较低。ED显著降低了首次尿路感染的发生率。1年时，只有20%的ED PTx发生了尿路感染，而BD PTx为63%（P = 0.0001）。
胰腺的肠道引流更符合生理，与膀胱引流结果相似，但感染并发症更少，尤其是尿路感染。
