Freise C E, Narumi S, Stock P G, Melzer J S
Department of Surgery, University of California, San Francisco 94143, USA.
West J Med. 1999 Jan;170(1):11-8.
Simultaneous pancreas-kidney transplantation (SPK) has become an accepted therapy for the treatment of patients with insulin-dependent diabetes mellitus and renal failure from diabetic nephropathy. The procedure has evolved over the last twenty years, and refinements in technique, better organ preservation solutions, and more potent immunosuppressive therapies have improved one-year graft-survival rates to 81% for the pancreas and 88% for the kidney (International Pancreas Transplant Registry Data-1996). Proper patient selection is important, given the increased complexity of the procedure, the increased need for immunosuppression, and the need for compliance with postoperative medications and monitoring. The benefits of a successful SPK include more physiologic glucose metabolism and freedom from dialysis. This review will describe the indications and selection process for potential candidates, outline the procedure and postoperative care, and discuss the potential impact on secondary complications of diabetes mellitus. It will then discuss results and complications from the use of current protocols and immunosuppression at the University of California at San Francisco.
胰肾联合移植（SPK）已成为治疗胰岛素依赖型糖尿病且因糖尿病肾病导致肾衰竭患者的一种公认疗法。在过去二十年中，该手术不断发展，技术的改进、更好的器官保存液以及更强效的免疫抑制疗法已将胰腺的一年移植物存活率提高到81%，肾脏提高到88%（国际胰腺移植登记处1996年数据）。鉴于手术复杂性增加、免疫抑制需求增加以及术后服药和监测的依从性要求，恰当的患者选择很重要。成功进行SPK的益处包括更生理性的葡萄糖代谢以及无需透析。本综述将描述潜在候选者的适应症和选择过程，概述手术及术后护理，并讨论对糖尿病继发并发症的潜在影响。然后将讨论加利福尼亚大学旧金山分校使用当前方案和免疫抑制的结果及并发症。
