Outcomes of Recipients With Pancreas Transplant Alone Who Develop End‐Stage Renal Disease

Recipients of pancreas transplant alone (PTA) may be at increased risk for developing end‐stage renal disease (ESRD). The survival experience of PTA recipients developing ESRD has not been described. Furthermore, the relative survival of these patients as compared to diabetics on chronic dialysis is unknown. We studied all adult PTA recipients from January 1, 1990 to September 1, 2008 using the Scientific Registry of Transplant Recipients. Each PTA recipient developing ESRD was matched to 10 diabetics on chronic dialysis from the United States Renal Data System. Cox proportional hazards models were fitted to determine the relation between ESRD and mortality among PTA recipients, and the relation between PTA and mortality among diabetics on chronic dialysis. There were 1597 PTA recipients in the study, of which 207 developed ESRD. Those with ESRD had a threefold increase in mortality versus those without (adjusted hazard ratio 3.28 [95% confidence interval: 2.27, 4.76]). There was no significant difference in the risk of death among PTA recipients with ESRD versus diabetics on dialysis. PTA recipients developing ESRD are three times more likely to die than PTA recipients without ESRD; however, the risk of death in these patients was similar to diabetics on chronic dialysis without PTA.     

基于“脾肾为本、血瘀为标”论绝经后骨质疏松症的病机及防治

绝经后骨质疏松症主要是由于绝经后妇女卵巢功能逐渐衰退,雌激素水平下降,使破骨细胞骨吸收的速度快于成骨细胞骨形成,从而引发进行性骨质流失。肾主骨生髓,为先天之本;脾主肉,为后天之本,运化水谷精微,共同促进骨骼的生长,绝经后骨质疏松症（postmenopausal osteoporosis,PMOP）多以脾肾渐虚为本,又因元气亏虚、肝气郁结、久病入络而致血行瘀滞,形成本虚标实之证。因此,笔者基于“脾虚为本、血瘀为标”思想探讨PMOP的病因病机,并凝练出“补肾-健脾-活血化瘀”之治则,从现代医学角度探讨这一治则的合理性,并在此治则的指导下探讨治未病3个阶段的防治思路,最后对中药和针灸防治PMOP进行综述,以期扩展临床思维。     

“邵氏五针法”辅助治疗卒中相关性肺炎疗效观察

目的:比较"邵氏五针法"配合常规西医治疗与单纯常规西医治疗卒中相关性肺炎的疗效。方法:将80例患者随机分为观察组和对照组,每组40例。对照组予抗感染等常规西药治疗配合康复吞咽训练。在对照组治疗的基础上,观察组采用"邵氏五针法"治疗,穴取肺俞、大椎、风门等,每日1次。两组均治疗10 d。比较两组患者治疗前后外周血炎性指标[白细胞(WBC)、C-反应蛋白(CRP)、中性粒细胞百分比(N%)],主要临床症状、体征消失时间,美国国立卫生研究院卒中量表(NIHSS)评分、日常生活能力(ADL)评分,并评定两组临床疗效。结果:治疗后,两组患者WBC、CRP、N%、NIHSS评分均较治疗前降低(P<0.05),ADL评分升高(P<0.05),且观察组以上指标较对照组改善更显著(P<0.05);观察组体温复常、咳嗽持续时间、啰音消失时间均短于对照组(P<0.05)。观察组有效率为97.5%(39/40),高于对照组的85.0%(34/40,P<0.05)。结论:"邵氏五针法"配合常规西医治疗能有效改善卒中相关性肺炎患者临床症状,降低炎性指标及提高患者生活质量,疗效优于单纯常规西医治疗。     

Early worsening of diabetic retinopathy after simultaneous pancreas and kidney transplantation—Myth or reality?

Early worsening of diabetic retinopathy due to sudden glucose normalization is a feared complication of pancreas transplantation; however, its rate or severity has not been studied prospectively. We followed up 43 pancreas and kidney recipients for a composite endpoint comprising new need for laser therapy, newly diagnosed proliferation, macular edema, visual acuity worsening, and blindness over 12 months. Although 37% of patients met this primary endpoint, its severity was rather low. Mean central retinal thickness and proportion of patients with subclinical macular edema increased significantly, with spontaneous resolution in half of them. Visual acuity did not change. There was no significant difference in the absolute glycated hemoglobin (HbA1c) drop, age, and diabetes duration between the patients who met and those who did not meet the primary endpoint, but a higher proportion of patients with worsening had a recent history of laser treatment. Retinopathy remained stable in 62.8% of patients. In 26%, the visual acuity significantly improved. Although retinopathy worsening was documented in more than one‐third of patients, its evolution was not related to the magnitude of metabolic change; rather, it corresponded to the expected natural course of retinopathy. Nonetheless, comprehensive ophthalmologic care should be a substantial component of the recipient management.     

OPTN/SRTR 2018 Annual Data Report: Pancreas

The overall number of pancreas transplants continued to increase to 1027 in 2018, after a nadir of 947 in 2015. New additions to waiting list remained stable, with 1485 candidates added in 2018. Proportions of patients with type II diabetes waiting for transplant (14.6%) and undergoing transplant (14.8%) have steadily increased since 2016. Waiting times for simultaneous pancreas/kidney transplant have decreased; median months to transplant was 13.5 for simultaneous pancreas/kidney transplant and 19.7 for pancreas transplant alone in 2018. Outcomes, including patient and kidney survival, as well as rejection rates, have improved consistently over the past several years. Pancreas graft survival data are being collected by the Organ Procurement and Transplantation Network and will be included in a future report once there are sufficient cohorts for analysis.