胰肾联合移植治疗Ⅰ型糖尿病合并终末期肾病

目的 探讨胰肾联合移植治疗Ⅰ型糖尿病合并终末期肾病的临床效果。方法 ８例Ⅰ型糖尿病合并终末期肾病的患者接受胰肾联合移植,平均年龄４３．４６岁,２例合并视网膜病变,双目失明,病史２～２２年。胰腺移植于右髂窝,胰腺外分泌经膀胱引流,肾脏移植于左髂窝。免疫抑制方案开始四联用药,以后三联用药继续治疗。结果 ８例虱其中７例术后即不需要应用胰岛素,空腹血糖可维持在正常范围,１例术后应用胰岛素４０ｄ后停用。１例

Simultaneous pancreas-kidney transplantation for the treatment of type I diabetes with end-stage renal disease

OBJECTIVE: To demonstrate whether simultaneous pancreas-kidney transplantation is practical for the treatment of Type I diabetes with end-stage renal disease. METHODS: Eight cases of combined pancreas-kidney transplantation were performed in our institute. The age ranged from 35 years to 48 years (average 43.46 years). All cases were diagnosed as type I diabetes with end-stage nephropathy, two cases with blindness due to retinopathy. The case history ranged from 2 years to 22 years. Pancreas allograft was placed in the right iliac fossa with pancreas exocrine drainage to bladder, whereas renal allograft the in left iliac fossa. Initial immunosuppression regimen is quadruple. RESULTS: Seven patient could be insulin free after transplantation, with normal fasting blood glucose. One patient received insulin treatment for 40 days after operation. One patient survived 1 year and 9 months after transplantation with normal functioning pancreas allograft and kidney allograft. Four patient survived 2 months with normal allograft function. Fasting blood glucose was between 4.5 and 6.2 mmol/L; Cr was between 53 and 106 micromol/L. Diet control was not necessary. Two patient died of encephalorrhagia, and 1 pancreatic vascular thrombosis and necrotic pancreatitis. CONCLUSIONS: Combined pancreas-kidney transplantation is feasible to treat type I diabetes with end-stage nephropathy. Functional pancreas allograft could be procured in the present condition. Pancreatic exocrine is drained to bladder. The diagnosis of acute rejection could be made earlier by detecting urine amylase. Heparin should be added in order to prevent pancreatic thrombosis.