移植物局部Th1和Th2型细胞因子在猪胰肾联合移植门脉和体静脉回流术式的表达及其意义

目的 探讨Th1和Th2型细胞因子在猪胰肾联合移植门脉(PVD)和体静脉(SVD)回流术式移植物局部表达及意义.方法 58例四川当地杂交第1代长白猪,分成假手术组(10例)、PE组(24例)和SE组(24例).假手术组行开腹术,PE组和SE组切除受者胰腺制成Ⅰ型糖尿病模型,并切除右肾.PE组门静脉与受者肠系膜上静脉吻合,SE组门静脉与受者肝下下腔静脉吻合,外分泌均采用肠道引流.术后第3、7天开腹取移植胰腺、肾脏组织,逆转录-聚合酶链反应(RT-PCR)和ELISA检测移植物局部Th1型细胞因子IFN-γ和Th2型细胞因子白细胞介素(IL)-4mRNA及蛋白的表达.结果 术后第3、7天,与对照组比较,移植肾和胰腺IFN-γ mRNA及蛋白在SE组和PE组均呈高表达(P<0.05),SE组高于PE组(P<0.05)(第7天,蛋白在对照组比SE组比PE组表达:移植胰腺,[(3.36±0.25)比(7.72±0.67)比(6.52±0.34)pg/mg蛋白],移植肾[(3.66±0.28)比(10.83±1.48)比(7.79±0.60)pg/mg蛋白].移植胰腺和肾IL-4 mRNA及蛋白在SE组和假手术组呈低表达,PE组呈高表达(P<0.05)(第7天,蛋白在对照组比SE组比PE组表达:移植胰腺,[(7.18±0.16)比(6.10±0.16)比(20.66±1.47)pg/mg蛋白];移植肾,[(5.74±0.48)比(10.38±0.92)比(19.66±1.57)pg/mg蛋白].结论 胰肾联合移植PVD术式移植物血流经过肝脏后可诱导,Th1细胞向Th2细胞偏离,是PVD免疫学优越性的可能机制.     

移植物局部Th1和Th2型细胞因子在猪胰肾联合移植门脉和体静脉回流术式的表达及其意义

Objective To investigate the expression and significance of local Th1 and Th2 cytokines in the grafts of pig simultaneous pancreas-kidney with portal versus systemic venous drainage. Methods Fifty-eight non-related and first hybrid landraces were divided into Sham (n = 10), PE (portal-enteric drainage) (n =24) and SE ( systemic-enteric drainage) (n =24) groups. Type 1 diabetic mellitus was induced by whole pancreatectomy ,and right-side nephrectomy was also performed in the recipients. The pigs in sham group were only subjected to ]aparotomy. The portal vein was anastomosed to superior mesenteric vein of the recipient in PE group or to the inferior hepatic cava of the recipients in SE group. The tissues of the graft pancreas and kidney were obtained by surgery for detecting the expression of mRNA and protein of IFN-γand IL4 by RT-PCR and ELISA on the day 3,and 7 after transplantation. Results Compared with sham group,the local expression of mRNA and protein of IFN in the graft pancreas and kidney of both SE and PE groups was significantly up-regulated ( P < 0. 05 ) ( On the day 7, protein expression in sham, SE, and PE groups :in the graft pancreas, [ (3.36±0.25 ), (7.72±0.67 ), and ( 6.52±0.34 ) pg/mg protein ];in the graft kidney, [ ( 3.66±0.28 ), ( 10.83±1.48 ), and (7.79±0.60) pg/mg protein ]. The local expression of mRNA and protein of IL-4 was significantly up-regulated in PE group (P < 0.05 ), but down-regulated or no expression was detected in group SE (on the day 7, protein expression in sham, SE, and PE groups:in the graft pancreas, [ (7.18±0.16), (6.10±0.16) ,and (20.66±1.47) pg/mg protein];in the graft kidney, [ (5.74±0.48) ,(10.38±0.92) ,and ( 19.66±1.57) pg/mg protein]. Conclusion That the blood flow of graft pancreas passes by liver in SPK with PVD can induce a Th1 to Th2 inmaune shift. This may be one of mechanisms of immunologic benefits of PVD.     

移植物局部Th1和Th2型细胞因子在猪胰肾联合移植门脉和体静脉回流术式的表达及其意义

Objective To investigate the expression and significance of local Th1 and Th2 cytokines in the grafts of pig simultaneous pancreas-kidney with portal versus systemic venous drainage. Methods Fifty-eight non-related and first hybrid landraces were divided into Sham (n = 10), PE (portal-enteric drainage) (n =24) and SE ( systemic-enteric drainage) (n =24) groups. Type 1 diabetic mellitus was induced by whole pancreatectomy ,and right-side nephrectomy was also performed in the recipients. The pigs in sham group were only subjected to ]aparotomy. The portal vein was anastomosed to superior mesenteric vein of the recipient in PE group or to the inferior hepatic cava of the recipients in SE group. The tissues of the graft pancreas and kidney were obtained by surgery for detecting the expression of mRNA and protein of IFN-γand IL4 by RT-PCR and ELISA on the day 3,and 7 after transplantation. Results Compared with sham group,the local expression of mRNA and protein of IFN in the graft pancreas and kidney of both SE and PE groups was significantly up-regulated ( P < 0. 05 ) ( On the day 7, protein expression in sham, SE, and PE groups :in the graft pancreas, [ (3.36±0.25 ), (7.72±0.67 ), and ( 6.52±0.34 ) pg/mg protein ];in the graft kidney, [ ( 3.66±0.28 ), ( 10.83±1.48 ), and (7.79±0.60) pg/mg protein ]. The local expression of mRNA and protein of IL-4 was significantly up-regulated in PE group (P < 0.05 ), but down-regulated or no expression was detected in group SE (on the day 7, protein expression in sham, SE, and PE groups:in the graft pancreas, [ (7.18±0.16), (6.10±0.16) ,and (20.66±1.47) pg/mg protein];in the graft kidney, [ (5.74±0.48) ,(10.38±0.92) ,and ( 19.66±1.57) pg/mg protein]. Conclusion That the blood flow of graft pancreas passes by liver in SPK with PVD can induce a Th1 to Th2 inmaune shift. This may be one of mechanisms of immunologic benefits of PVD.     

移植物局部Th1和Th2型细胞因子在猪胰肾联合移植门脉和体静脉回流术式的表达及其意义

Objective To investigate the expression and significance of local Th1 and Th2 cytokines in the grafts of pig simultaneous pancreas-kidney with portal versus systemic venous drainage. Methods Fifty-eight non-related and first hybrid landraces were divided into Sham (n = 10), PE (portal-enteric drainage) (n =24) and SE ( systemic-enteric drainage) (n =24) groups. Type 1 diabetic mellitus was induced by whole pancreatectomy ,and right-side nephrectomy was also performed in the recipients. The pigs in sham group were only subjected to ]aparotomy. The portal vein was anastomosed to superior mesenteric vein of the recipient in PE group or to the inferior hepatic cava of the recipients in SE group. The tissues of the graft pancreas and kidney were obtained by surgery for detecting the expression of mRNA and protein of IFN-γand IL4 by RT-PCR and ELISA on the day 3,and 7 after transplantation. Results Compared with sham group,the local expression of mRNA and protein of IFN in the graft pancreas and kidney of both SE and PE groups was significantly up-regulated ( P < 0. 05 ) ( On the day 7, protein expression in sham, SE, and PE groups :in the graft pancreas, [ (3.36±0.25 ), (7.72±0.67 ), and ( 6.52±0.34 ) pg/mg protein ];in the graft kidney, [ ( 3.66±0.28 ), ( 10.83±1.48 ), and (7.79±0.60) pg/mg protein ]. The local expression of mRNA and protein of IL-4 was significantly up-regulated in PE group (P < 0.05 ), but down-regulated or no expression was detected in group SE (on the day 7, protein expression in sham, SE, and PE groups:in the graft pancreas, [ (7.18±0.16), (6.10±0.16) ,and (20.66±1.47) pg/mg protein];in the graft kidney, [ (5.74±0.48) ,(10.38±0.92) ,and ( 19.66±1.57) pg/mg protein]. Conclusion That the blood flow of graft pancreas passes by liver in SPK with PVD can induce a Th1 to Th2 inmaune shift. This may be one of mechanisms of immunologic benefits of PVD.     

移植物局部Th1和Th2型细胞因子在猪胰肾联合移植门脉和体静脉回流术式的表达及其意义

Objective To investigate the expression and significance of local Th1 and Th2 cytokines in the grafts of pig simultaneous pancreas-kidney with portal versus systemic venous drainage. Methods Fifty-eight non-related and first hybrid landraces were divided into Sham (n = 10), PE (portal-enteric drainage) (n =24) and SE ( systemic-enteric drainage) (n =24) groups. Type 1 diabetic mellitus was induced by whole pancreatectomy ,and right-side nephrectomy was also performed in the recipients. The pigs in sham group were only subjected to ]aparotomy. The portal vein was anastomosed to superior mesenteric vein of the recipient in PE group or to the inferior hepatic cava of the recipients in SE group. The tissues of the graft pancreas and kidney were obtained by surgery for detecting the expression of mRNA and protein of IFN-γand IL4 by RT-PCR and ELISA on the day 3,and 7 after transplantation. Results Compared with sham group,the local expression of mRNA and protein of IFN in the graft pancreas and kidney of both SE and PE groups was significantly up-regulated ( P < 0. 05 ) ( On the day 7, protein expression in sham, SE, and PE groups :in the graft pancreas, [ (3.36±0.25 ), (7.72±0.67 ), and ( 6.52±0.34 ) pg/mg protein ];in the graft kidney, [ ( 3.66±0.28 ), ( 10.83±1.48 ), and (7.79±0.60) pg/mg protein ]. The local expression of mRNA and protein of IL-4 was significantly up-regulated in PE group (P < 0.05 ), but down-regulated or no expression was detected in group SE (on the day 7, protein expression in sham, SE, and PE groups:in the graft pancreas, [ (7.18±0.16), (6.10±0.16) ,and (20.66±1.47) pg/mg protein];in the graft kidney, [ (5.74±0.48) ,(10.38±0.92) ,and ( 19.66±1.57) pg/mg protein]. Conclusion That the blood flow of graft pancreas passes by liver in SPK with PVD can induce a Th1 to Th2 inmaune shift. This may be one of mechanisms of immunologic benefits of PVD.     

移植物局部Th1和Th2型细胞因子在猪胰肾联合移植门脉和体静脉回流术式的表达及其意义

Objective To investigate the expression and significance of local Th1 and Th2 cytokines in the grafts of pig simultaneous pancreas-kidney with portal versus systemic venous drainage. Methods Fifty-eight non-related and first hybrid landraces were divided into Sham (n = 10), PE (portal-enteric drainage) (n =24) and SE ( systemic-enteric drainage) (n =24) groups. Type 1 diabetic mellitus was induced by whole pancreatectomy ,and right-side nephrectomy was also performed in the recipients. The pigs in sham group were only subjected to ]aparotomy. The portal vein was anastomosed to superior mesenteric vein of the recipient in PE group or to the inferior hepatic cava of the recipients in SE group. The tissues of the graft pancreas and kidney were obtained by surgery for detecting the expression of mRNA and protein of IFN-γand IL4 by RT-PCR and ELISA on the day 3,and 7 after transplantation. Results Compared with sham group,the local expression of mRNA and protein of IFN in the graft pancreas and kidney of both SE and PE groups was significantly up-regulated ( P < 0. 05 ) ( On the day 7, protein expression in sham, SE, and PE groups :in the graft pancreas, [ (3.36±0.25 ), (7.72±0.67 ), and ( 6.52±0.34 ) pg/mg protein ];in the graft kidney, [ ( 3.66±0.28 ), ( 10.83±1.48 ), and (7.79±0.60) pg/mg protein ]. The local expression of mRNA and protein of IL-4 was significantly up-regulated in PE group (P < 0.05 ), but down-regulated or no expression was detected in group SE (on the day 7, protein expression in sham, SE, and PE groups:in the graft pancreas, [ (7.18±0.16), (6.10±0.16) ,and (20.66±1.47) pg/mg protein];in the graft kidney, [ (5.74±0.48) ,(10.38±0.92) ,and ( 19.66±1.57) pg/mg protein]. Conclusion That the blood flow of graft pancreas passes by liver in SPK with PVD can induce a Th1 to Th2 inmaune shift. This may be one of mechanisms of immunologic benefits of PVD.     

移植物局部Th1和Th2型细胞因子在猪胰肾联合移植门脉和体静脉回流术式的表达及其意义

Objective To investigate the expression and significance of local Th1 and Th2 cytokines in the grafts of pig simultaneous pancreas-kidney with portal versus systemic venous drainage. Methods Fifty-eight non-related and first hybrid landraces were divided into Sham (n = 10), PE (portal-enteric drainage) (n =24) and SE ( systemic-enteric drainage) (n =24) groups. Type 1 diabetic mellitus was induced by whole pancreatectomy ,and right-side nephrectomy was also performed in the recipients. The pigs in sham group were only subjected to ]aparotomy. The portal vein was anastomosed to superior mesenteric vein of the recipient in PE group or to the inferior hepatic cava of the recipients in SE group. The tissues of the graft pancreas and kidney were obtained by surgery for detecting the expression of mRNA and protein of IFN-γand IL4 by RT-PCR and ELISA on the day 3,and 7 after transplantation. Results Compared with sham group,the local expression of mRNA and protein of IFN in the graft pancreas and kidney of both SE and PE groups was significantly up-regulated ( P < 0. 05 ) ( On the day 7, protein expression in sham, SE, and PE groups :in the graft pancreas, [ (3.36±0.25 ), (7.72±0.67 ), and ( 6.52±0.34 ) pg/mg protein ];in the graft kidney, [ ( 3.66±0.28 ), ( 10.83±1.48 ), and (7.79±0.60) pg/mg protein ]. The local expression of mRNA and protein of IL-4 was significantly up-regulated in PE group (P < 0.05 ), but down-regulated or no expression was detected in group SE (on the day 7, protein expression in sham, SE, and PE groups:in the graft pancreas, [ (7.18±0.16), (6.10±0.16) ,and (20.66±1.47) pg/mg protein];in the graft kidney, [ (5.74±0.48) ,(10.38±0.92) ,and ( 19.66±1.57) pg/mg protein]. Conclusion That the blood flow of graft pancreas passes by liver in SPK with PVD can induce a Th1 to Th2 inmaune shift. This may be one of mechanisms of immunologic benefits of PVD.     

移植物局部Th1和Th2型细胞因子在猪胰肾联合移植门脉和体静脉回流术式的表达及其意义

Objective To investigate the expression and significance of local Th1 and Th2 cytokines in the grafts of pig simultaneous pancreas-kidney with portal versus systemic venous drainage. Methods Fifty-eight non-related and first hybrid landraces were divided into Sham (n = 10), PE (portal-enteric drainage) (n =24) and SE ( systemic-enteric drainage) (n =24) groups. Type 1 diabetic mellitus was induced by whole pancreatectomy ,and right-side nephrectomy was also performed in the recipients. The pigs in sham group were only subjected to ]aparotomy. The portal vein was anastomosed to superior mesenteric vein of the recipient in PE group or to the inferior hepatic cava of the recipients in SE group. The tissues of the graft pancreas and kidney were obtained by surgery for detecting the expression of mRNA and protein of IFN-γand IL4 by RT-PCR and ELISA on the day 3,and 7 after transplantation. Results Compared with sham group,the local expression of mRNA and protein of IFN in the graft pancreas and kidney of both SE and PE groups was significantly up-regulated ( P < 0. 05 ) ( On the day 7, protein expression in sham, SE, and PE groups :in the graft pancreas, [ (3.36±0.25 ), (7.72±0.67 ), and ( 6.52±0.34 ) pg/mg protein ];in the graft kidney, [ ( 3.66±0.28 ), ( 10.83±1.48 ), and (7.79±0.60) pg/mg protein ]. The local expression of mRNA and protein of IL-4 was significantly up-regulated in PE group (P < 0.05 ), but down-regulated or no expression was detected in group SE (on the day 7, protein expression in sham, SE, and PE groups:in the graft pancreas, [ (7.18±0.16), (6.10±0.16) ,and (20.66±1.47) pg/mg protein];in the graft kidney, [ (5.74±0.48) ,(10.38±0.92) ,and ( 19.66±1.57) pg/mg protein]. Conclusion That the blood flow of graft pancreas passes by liver in SPK with PVD can induce a Th1 to Th2 inmaune shift. This may be one of mechanisms of immunologic benefits of PVD.     

移植物局部Th1和Th2型细胞因子在猪胰肾联合移植门脉和体静脉回流术式的表达及其意义

Objective To investigate the expression and significance of local Th1 and Th2 cytokines in the grafts of pig simultaneous pancreas-kidney with portal versus systemic venous drainage. Methods Fifty-eight non-related and first hybrid landraces were divided into Sham (n = 10), PE (portal-enteric drainage) (n =24) and SE ( systemic-enteric drainage) (n =24) groups. Type 1 diabetic mellitus was induced by whole pancreatectomy ,and right-side nephrectomy was also performed in the recipients. The pigs in sham group were only subjected to ]aparotomy. The portal vein was anastomosed to superior mesenteric vein of the recipient in PE group or to the inferior hepatic cava of the recipients in SE group. The tissues of the graft pancreas and kidney were obtained by surgery for detecting the expression of mRNA and protein of IFN-γand IL4 by RT-PCR and ELISA on the day 3,and 7 after transplantation. Results Compared with sham group,the local expression of mRNA and protein of IFN in the graft pancreas and kidney of both SE and PE groups was significantly up-regulated ( P < 0. 05 ) ( On the day 7, protein expression in sham, SE, and PE groups :in the graft pancreas, [ (3.36±0.25 ), (7.72±0.67 ), and ( 6.52±0.34 ) pg/mg protein ];in the graft kidney, [ ( 3.66±0.28 ), ( 10.83±1.48 ), and (7.79±0.60) pg/mg protein ]. The local expression of mRNA and protein of IL-4 was significantly up-regulated in PE group (P < 0.05 ), but down-regulated or no expression was detected in group SE (on the day 7, protein expression in sham, SE, and PE groups:in the graft pancreas, [ (7.18±0.16), (6.10±0.16) ,and (20.66±1.47) pg/mg protein];in the graft kidney, [ (5.74±0.48) ,(10.38±0.92) ,and ( 19.66±1.57) pg/mg protein]. Conclusion That the blood flow of graft pancreas passes by liver in SPK with PVD can induce a Th1 to Th2 inmaune shift. This may be one of mechanisms of immunologic benefits of PVD.     

移植物局部Th1和Th2型细胞因子在猪胰肾联合移植门脉和体静脉回流术式的表达及其意义

Objective To investigate the expression and significance of local Th1 and Th2 cytokines in the grafts of pig simultaneous pancreas-kidney with portal versus systemic venous drainage. Methods Fifty-eight non-related and first hybrid landraces were divided into Sham (n = 10), PE (portal-enteric drainage) (n =24) and SE ( systemic-enteric drainage) (n =24) groups. Type 1 diabetic mellitus was induced by whole pancreatectomy ,and right-side nephrectomy was also performed in the recipients. The pigs in sham group were only subjected to ]aparotomy. The portal vein was anastomosed to superior mesenteric vein of the recipient in PE group or to the inferior hepatic cava of the recipients in SE group. The tissues of the graft pancreas and kidney were obtained by surgery for detecting the expression of mRNA and protein of IFN-γand IL4 by RT-PCR and ELISA on the day 3,and 7 after transplantation. Results Compared with sham group,the local expression of mRNA and protein of IFN in the graft pancreas and kidney of both SE and PE groups was significantly up-regulated ( P < 0. 05 ) ( On the day 7, protein expression in sham, SE, and PE groups :in the graft pancreas, [ (3.36±0.25 ), (7.72±0.67 ), and ( 6.52±0.34 ) pg/mg protein ];in the graft kidney, [ ( 3.66±0.28 ), ( 10.83±1.48 ), and (7.79±0.60) pg/mg protein ]. The local expression of mRNA and protein of IL-4 was significantly up-regulated in PE group (P < 0.05 ), but down-regulated or no expression was detected in group SE (on the day 7, protein expression in sham, SE, and PE groups:in the graft pancreas, [ (7.18±0.16), (6.10±0.16) ,and (20.66±1.47) pg/mg protein];in the graft kidney, [ (5.74±0.48) ,(10.38±0.92) ,and ( 19.66±1.57) pg/mg protein]. Conclusion That the blood flow of graft pancreas passes by liver in SPK with PVD can induce a Th1 to Th2 inmaune shift. This may be one of mechanisms of immunologic benefits of PVD.     

Impact of portal versus systemic venous drainage on acute rejection of simultaneous pancreas-kidney transplantation in pig

BACKGROUND: The immunological benefits of portal venous drainage (PVD) in pancreas transplantation remain debated clinically. We established simultaneous pancreas-kidney transplantation (SPK) models with portal venous drainage and systemic venous drainage to compare the impact of venous drainage site on acute rejection in pig. METHODS: Forty-eight nonrelated, first hybrid landrace pigs were divided into PE (portal-enteric drainage) and SE (systemic-enteric drainage) groups. Type I diabetes mellitus was induced by whole pancreatectomy, and right-side nephrectomy was also performed in the recipients. The donor portal vein was anastomosed to superior mesenteric vein of the recipients in PE group or to the inferior hepatic cava vena of the recipients in SE group. Graft tissue specimens were obtained with laparotomy on Day 3 and 7 after transplant, and the severity of acute rejection was scored according to Nakhleh and Banff criteria. RESULTS: The cold ischemia time, fasting plasma glucose and urine creatinine of the 2 groups had no statistic difference between 2 groups at Day 1, 3, 5, and 7 after transplant (P>0.05). The occurrence of both pancreas and kidney acute rejections in PE group was significant later and slighter than SE group (P<0.05). CONCLUSION: PVD, compared with SVD, could ameliorate and delay acute rejection in pig SPK. It might become a tolerance inducing method of pancreas transplantation, decrease the cost and improve the quality of SPK, if further confirmed by clinical trials.     

Simultaneous pancreas-kidney transplantation: portal versus systemic venous drainage of the pancreas allografts

Simultaneous pancreas-kidney (SPK) transplantation is considered a valid therapeutic option for patient with type I diabetes mellitus and end-stage diabetic nephropathy. This study was performed to determine whether the technique of pancreas venous drainage affects patient survival as well as graft survival and function. From October 1996 to April 1999 34 uremic patients with type I diabetes mellitus were randomly assigned to two groups: the first group (SV group=17) received SPK transplantation with systemic venous drainage, and the second group (PV group=17) received pancreas allograft with portal drainage. A Roux-en-Y loop was performed in all the patients. Patient follow-up included clinical course and metabolic studies. At 1 yr, patient survival rates were 88.2% in the SV group and 94.1% in the PV group while graft survival rate was 76.4% in both groups. Several surgical complications were attributed to the enteric drainage without any graft failure in both groups. One venous thrombosis occurred in each group. No significant differences have been evidenced in kidney and pancreas function. The preliminary results of this randomized trial did not evidence any significant differences between portal and systemic venous drainage of pancreas allograft.     

Bladder vs enteric drainage in simultaneous pancreas-kidney transplantation.

BACKGROUND: As a valid therapeutic option for patients with type 1 diabetes mellitus (IDDM) and secondary diabetic nephropathy, simultaneous pancreas-kidney (SPK) transplantation remains more undeveloped than other solid organ transplantations due to restrictions of surgical techniques, especially modes of exocrine pancreatic secretion. Enteric drainage (ED) has recently been increasingly popular due to the long-term complications with bladder drainage (BD). Objectives. Compare results of SPK transplants with enteric vs bladder exocrine drainage since the beginning of our experience with this type of transplantation. METHODS: From March 1998 to October 2004, 53 SPK transplants were performed, consisting of 30 with bladder drainage (BD) and 23 with enteric drainage (ED). Induction therapy included antilymphocyte globulin (ALG) or anti-CD25 monoclonal antibody. Maintenance regimen consisted of tacrolimus (TAC)/cyclosporine (CsA), mycophenolate mofetil (MMF) and steroids. RESULTS: Mean age of recipients was 39+/-7 in both groups. No anastomosis leakage occurred in either group. Surgical complications were not significantly different between the two groups. Incidence of acute rejection, major infections and cytomegalovirus disease were also similar. However, the BD group was characterized by a slight increase in number of urologic complications, metabolic acidosis and dehydration. The length of initial hospital stay was likewise comparable. All patients with a functional graft no longer required exogenous insulin. BD actuarial patient survival and graft three-year survival were 96 and 86%, respectively. For ED, the respective results were 97 and 91%, respectively. CONCLUSION: Compared with BD, perioperative morbidity is not increased by ED, and ED is not associated with increased long-term pancreas graft failure. These data suggest that ED is superior to BD and should be considered as the preferred technique for simultaneous pancreas-kidney transplants.     

Effects of portal versus systemic venous drainage in kidney-pancreas recipients

A randomized study of combined kidney-pancreas transplantation was performed on 30 insulin-dependent diabetic patients with end-stage renal disease to compare the consequences of pancreas transplantation with portal venous (PV) and systemic venous (SV) drainage. Fourteen patients (SV group) received systemically drained and sixteen (PV group) portally drained pancreas allografts. Enteric drainage was performed in both groups. The routine follow-up included documentation of the clinical course and detailed endocrine studies. At 1 year after transplantation, the patient survival rate was 92 % for the SV group and 96 % for the PV group; the graft survival rate was 78 % and 82 %, respectively. Endocrine studies indicated no difference in fasting and stimulated glucose or in glycosylated hemoglobin between the two groups. In addition, no hyperinsulinemia and lipidic abnormalities were evidenced in either group Long-term studies are required to conclude whether PV and SV drainage in pancreas transplantation are equivalent in terms of patient and graft survival as well as metabolic consequences. Received: 9 July 1999/Accepted: 8 October 1999     

Impact of pancreatic venous drainage site on long-term patient and graft outcome in simultaneous pancreas-kidney transplantation

The impact of portal or systemic venous pancreas graft drainage on patient and graft outcome remains controversial. In the present study, the impact of venous drainage type on long-term patient and graft survival is assessed. From July 1996 to December 2002 80 simultaneous pancreas-kidney transplants were enrolled into a prospective study: 44 received a pancreas allograft with portal (P-SPK group) and 36 with systemic venous drainage (S-SPK group). Enteric exocrine drainage was performed in all recipients receiving the same immunosuppressive treatment. At one yr, the patient survival rates were 91.7% and 95.5% both for S-SPK and P-SPK groups, respectively; no significant difference in survival was shown at any time point of the follow-up. The one-, three-, five-, and eight-yr pancreas survival rates were 75%, 60.6%, 56.7%, and 44%, respectively in the S-SPK group compared to 88.6%, 84.1%, 78.4%, and 31.3% in the P-SPK group. The one-, three-, five-, and eight-yr kidney survival rates were 91.7%, 78.15%, 74.1%, and 57.9%, respectively in the S-SPK group compared to 93.2%, 88.6%, 78.4%, and 38.9% in the P-SPK group. Comparing the two groups, no significant difference was shown in the total number of surgical complications as well as in the number of each complication. No significant difference in long-term outcomes between the two groups was shown, even if in S-SPK group a higher incidence of pancreas graft loss has been reported and it was in part correlated to a higher number of graft thromboses.     

胰肾联合移植术后排斥反应分析

目的 探讨预防和逆转胰肾联合移植术后排斥反应的方法。方法 回顾性分析1999年9月～2003年9月17例同种异体胰肾联合移植手术患者的临床资料。全部病例采用口服免疫抑制剂：环孢素A、霉酚酸酯或硫唑嘌呤、激素三联用药。其中2例术前及术后第5天应用抗IL-2R单克隆抗体,3例应用OKT3进行免疫诱导。结果 17例患者中1例发生移植胰腺、肾脏加速性排斥反应．经保守治疗无效,切除移植物;8例发生急性排斥反应,其中单纯肾脏排斥反应6例,同时累及胰腺、肾脏的排斥反应2例,经甲泼尼龙或OKT3治疗后均逆转。结论 胰肾联合移植术后合理应用免疫抑制剂。术前采用综合措施降低高危受者的致敏性,是预防和治疗排斥反应的有效方法。