Experience with simultaneous pancreas-kidney transplantation.

With refinements in surgical techniques and increased clinical experience, there has been a resurgence of interest in vascularized pancreas transplantation. From December 1986 to April 1988, 30 whole-organ vascularized pancreas transplants with pancreatico duodenocystostomy were performed simultaneously with renal transplantation. The recipient population consisted of 20 men and ten women, with a mean age of 34.7 years (range of 25-53 years). The mean duration of insulin-dependent diabetes mellitus (IDDM) was 22.6 years (range of 10-37 years). The mean pancreas preservation time was 8.7 hours (range 3-19 years). All patients were immediately insulin-independent. Simultaneous pancreas-kidney engraftment was performed to both iliac fossae via a lower midline incision (n = 28) or through a bilateral lower abdominal incision (n = 2). The mean operating time was 5.9 hours, and packed cell transfusion requirement was 1.3 units. The mean length of hospital stay was 27.4 days. Recipients averaged 2.3 admissions (1-7), with ten patients (34.4%) requiring only one hospital admission. Postoperative immunosuppression consisted of cyclosporine, prednisone, azathioprine, and Minnesota antilymphoblast globulin (MALG). A total of 49 episodes of rejection occurred in 26 patients. Actuarial patient survival rate at two years is 96.3%. The kidney and pancreas survival rates for the same time interval is 94.0% and 84.0%, respectively. Mean serum creatinine at present is 1.75 mg/dl. In conclusion, renal transplantation in concert with pancreas transplantation has a dramatic positive impact on pancreas allograft survival. Combined engraftment does not appear to jeopardize renal allograft functional survival. In view of these results, simultaneous pancreas-kidney transplantation appears to be the treatment of choice for Type I diabetic patients.     

胰肾联合移植术后死亡原因分析

目的分析肠道引流式胰肾联合移植术后死亡原因。方法回顾分析我院2001年5月至2006年10月开展的10例胰肾联合移植治疗终末期糖尿病并发尿毒症患者的临床资料，分析胰肾联合移植术后死亡的原因。结果3例胰肾联合移植术后死亡，其中2例死于肺部感染，1例死于缺血坏死性胰腺炎。结论胰肾联合移植术风险较大，肺部感染、缺血坏死性胰腺炎是术后死亡的主要原因。     

胰肾联合移植的排斥反应

目的　探讨胰肾联合移植术后的排斥反应。方法　对我院施行的 3例胰肾联合移植的病人 ,采用FK5 0 6 MMF Perid Zenapax四联免疫治疗方案 ,通过床边彩超及Cr、BUN、血糖等来监测移植物的排斥反应。对排斥反应采用激素冲击疗法 ,对激素不敏感者采用OKT3治疗。结果　3例患者中有 2例出现排斥反应 ,其发生率达 6 6 % ;在出现排斥反应时 ,首先表现为低热、全身不适 ,尿量减少 ,血Cr、BUN升高 ,彩超示移植物血流阻抗升高 ,之后才是血糖升高。结论　胰肾联合移植中 ,排斥反应与多种因素有关 ,移植肾对移植胰具有保护作用 ,肾脏可以作为监测胰腺排异的窗口 ,彩超检查可以作为筛选移植物排异反应的手段。     

全胰、肾一期联合移植一例

目的 总结临床胰、肾联合移植的经验与教训。方法 对１例胰岛素依赖型糖尿病合并尿毒症患者施行膀胱引流式尸体全胰、十二指肠及肾一期联合移植。术后采用包括抗淋巴细胞诱导的四联序贯免疫抑制方案,维持免疫抑制彩环孢素Ａ、泼尼松和霉酚酸酯组成的三联方案。结果 术后第４ｄ,移植肾和胰腺功能恢复良好,血肌酐、尿素氮及空腹血糖降至正常,术后２０ｄ,完全停用胰岛素,患者现已存活９个月,情况良好。结论 胰、肾联合移植应     

Cytomegalovirus infection in simultaneous pancreas-kidney transplantation

INTRODUCTION: In this open-label multicenter study, 205 simultaneous pancreas-kidney (SPK) transplant recipients between 1998 and 2000 were randomly assigned to tacrolimus or cyclosporine-microemulsion (ME). All patients received concomitant rATG induction therapy, mycophenolate mofetil and short-term corticosteroids. We report the 3-year data related to the occurrence, severity and effect of cytomegalovirus (CMV) infections. The type of CMV prophylaxis and treatment was at the discretion of the investigator. RESULTS: The overall incidence of CMV infection was 34% with no difference in incidence between the tacrolimus and cyclosporine-ME treatment arms. Statistically significant fewer CMV infections occurred among patients who received ganciclovir (22%) than those who did not receive prophylaxis (42%; P = .0075) or were treated with acyclovir (43%; P = .0066). The CMV infection rate according to donor recipient CMV serological status was: D-/R- group 11%, which was lower than the D-/R+ group at 40% (P = .0035), the D+/R+ group at 37% (P = .0024), or the D+/R- group at 52% (P = .00001). Among the last three groups, the infection rate was lower in patients on ganciclovir than those with no prophylaxis or on acyclovir (22% vs 64%; P = .00001). The incidence of acute rejection episodes was higher among patients without ganciclovir prophylaxis. No difference was observed in actuarial patient, kidney, or pancreas survival rates between patients with versus without infection. CONCLUSIONS: Ganciclovir prophylaxis effectively prevented CMV infection in SPK transplant recipients, especially in higher risk groups. An effect of CMV prophylaxis on the incidence of rejection is possible.     

Cardiovascular events after simultaneous pancreas-kidney transplantation

Objective

To retrospectively evaluate the incidence of cardiovascular events after functioning simultaneous pancreas-kidney transplantation (SPKT).

Patients and Methods

Cardiovascular events after 89 SPKT procedures performed at our institution from March 1995 to March 2009 were investigated. Study criteria included normal functioning of both grafts. Patients included 36 women and 53 men, with mean (range) age of 37.7 (25-66) years. Duration of diabetes mellitus was 23.6 (10-48) years, and of dialysis therapy was 19.8 (0-70) months. The exocrine pancreatic secretions were drained to the bladder in 41 patients, and enterically in 45 patients. Mean (SD) follow-up was 58.62 (34.74) months.

Results

During follow-up after SPKT, 9 patients (10.1%) experienced cardiovascular events including cerebrovascular accident in 4 patients, myocardial infarction (MI) in 3, and episodes of angina pectoris without evidence of coronary artery disease in 2 patients. Nevertheless, these two patients had sustained an MI that required coronary angioplasty before SPKT. Moreover, coronary angioplasty was required in 2 patients before they were enrolled in the transplantation program because of silent coronary artery disease. Four of 9 cardiovascular events occurred in the perioperative period. No deaths occurred due to cardiovascular events. Patient survival rate was 100%, with both grafts functioning in 87 (97.8%).

Conclusion

Cardiovascular events occur relatively frequently in patients undergoing SPKT. In the present study, most events occurred in the perioperative period, but did not result in death.     

肠道-腔静脉引流的胰肾联合移植术

目的 探讨肠道-下腔静脉引流的胰肾联合移植术的手术操作及临床效果.方法 对3例慢性肾衰竭合并2型糖尿病患者施行肠道-腔静脉引流的胰肾联合移植术,3例均为首次移植,年龄52、58、58岁.每日胰岛素用量20～55 U.供体切取均采用多器官联合切取.热缺血时间8～12 min,供体修整均采用肝总动脉与胃十二指肠动脉端-端吻合以重建十二指肠动脉弓,利用供体髂总静脉延长供体门静脉,切除供体脾脏.以供体髂内动脉与供肾动脉端-端吻合备用.受者手术采用右下腹经腹直肌切口,游离腔静脉下段及右侧髂外动静脉,取动脉延长之供肾,将供肾静脉与受者髂外静脉行端-侧吻合,将供体髂总动脉与受者髂外动脉行端-侧吻合,供体髂外动脉(残端修整成斜面)以动脉夹暂时夹闭备用,十字切开侧腹膜,将供肾埋入,输尿管经腹膜外隧道牵至膀胱底行膀胱输尿管吻合术,胰腺移植采用供体门静脉与受者下腔静脉行端-侧吻合,腹腔干-肠系膜上动脉之腹主动脉袖片与供体髂外动脉残端吻合,开放血流后行供体十二指肠与受体小肠侧侧吻合并关闭十二指肠残端.术后保留胃肠减压,待患者胃肠道功能恢复后拔除.每4 h测血糖、每6 h测血清及胰周引流液淀粉酶1次,每日超声监测胰腺及肾脏血流,生长抑素0.1 mg皮下注射8 h 1次,2周后停用.免疫诱导采用抗胸腺细胞免疫球蛋白减激素方案.结果 3例患者手术过程顺利,手术时间分别为7.5、8.0及10.0 h,术中失血量300～500 ml,仅1例术中输注浓缩红细胞2 U.术后1～3 d内完全停用胰岛素.术后3～7 d内移植肾功能恢复正常.实验室检查SCr分别为86、98及112μmol/L.1例术后10 d出现消化道出血,考虑为肠道吻合口出血;停用抗凝药.给予止血药及输血6 U治疗后1 d出血停止.3例随访2～6个月,无排斥反应发生,空腹及餐后血糖正常.结论 利用供体髂动脉搭桥的方法进行的胰肾同侧联合移植术手术操作简单,创伤较小而且仪使用一侧髂血管,对于左侧髂动脉硬化严重的患者仍可施行该术式.因而扩大了受者的范围;为患者保留一侧髂血管,为今后再次肾移植创造了条件.同时腔静脉引流的胰肾联合移植术使供体门静脉与脾静脉的夹角更符合生理角度,可能减少脾静脉血栓形成的发生率.     

Sexual dysfunction after simultaneous pancreas-kidney transplantation

Simultaneous pancreas-kidney transplantation (SPK) is the treatment of choice for patients with type 1 diabetes mellitus and end-stage renal disease (ESRD) because it improves survival, is cost-effective, and can mitigate secondary complications of diabetes. Patient-reported outcomes such as quality of life (QoL) have recently received increased attention among transplant recipients. However, the impact of erectile dysfunction on patient QoL has not been investigated in this high-risk group with a history of diabetes and uremia. We applied the International Index of Erectile Function (IIEF) to describe the prevalence and severity of self-reported changes in erectile function after transplantation, comparing the quality of well-being (QWB) index of subgroups of 101 consecutive male SPK recipients with varying degrees of erectile function. Only 21% of patients did not suffer from erectile dysfunction; 18% were classified as mild erectile dysfunction, 31% as mild to moderate, 21% as moderate, and 9% as severe according to the IIEF scores. Forty-one percent of patients reported subjective overall improvement in erectile dysfunction compared with their pretransplant status; 7% considered their sexual function to be worse than before, and 51% did not note any change. The QWB index was highest among the group of patients without erectile dysfunction, decreasing gradually but significantly with increasing severity. A direct impact of erectile dysfunction on QoL, as well as a confounding effect of underlying vascular comorbidities, could explain this finding.     

胰肾联合移植术麻醉方法的选择

目的 探讨适合胰肾联合移植手术的麻醉方法。方法 选择30例胰肾联合移植的患者，根据其术中麻醉方法分为硬膜外阻滞复合持续静脉镇静麻醉（EA组）和静脉输注联合吸入复合全身麻醉（GA组），每组15例。观察各组患者的手术时间、液体出入量、以及血管活性药、葡萄糖和胰岛素的用量，监测术中的心电图（ECG）、血氧饱和度（SpO2）、平均动脉压（MAP）、中心静脉压（CVP）、动脉血气和血糖水平，术后观察移植物功能和肺部并发症。结果 胰肾联合移植术中，EA组胰岛素用量较GA组少，但其葡萄糖及血管活性药物的用量较GA组多（P〈0．05）；EA组术中血流动力学波动较大，与GA组比较，差异有统计学意义（P〈0．05）。EA组术后有5例患者发现明显的肺部并发症，GA组有8例。EA组有8例患者术后1d内使用胰岛素，而GA组仅有4例。结论 胰肾联合移植手术中选择连续硬膜外阻滞复合静脉镇静麻醉，可减少术后肺部并发症，有利于胰腺功能的恢复，但须注意其对血流动力学的影响。     

Thrombotic microangiopathy after simultaneous pancreas-kidney transplantation

Thrombotic microangiopathy (TMA) is rare after transplantation and is associated with a high incidence of kidney graft dysfunction. Between December 2000 and March 2006, 136 simultaneous pancreas-kidney transplantations were performed with an incidence of TMA of 5.1% (71.4% localized to kidney allograft). All cases were diagnosed during the first three months and were attributed to tacrolimus; 74% were women. Systemic TMA presented higher values of lactate dehydrogenase (2658 +/- 659 U/L vs. 1331 +/- 473 U/L, p = 0.04) and a greater decrease in hematocrit (45.8 +/- 17.7% vs. 19.2 +/- 6%, p = 0.02) than in localized TMA. Acute kidney rejection complicated almost 90% of the cases with 43% of kidney graft lost. Tacrolimus was switched to sirolimus and fresh-frozen plasma was administered. Creatinine clearance after a mean follow-up of two yr was 100.7 mL/min/1.73 m(2) and 57.9 mL/min/1.73 m(2) in patients with systemic and localized TMA, respectively. In conclusion, sirolimus is an alternative to TMA associated with tacrolimus.     

Immunosuppressive drugs after simultaneous pancreas-kidney transplantation

INTRODUCTION: We report the early and late secondary effects of tacrolimus or cyclosporine-microemulsion (ME), in combination with mycophenolate mofetil (MMF), and rATG. PATIENTS AND METHODS: One hundred three patients were randomly assigned to tacrolimus (initial oral dose 0.2 mg/kg) and 102 to cyclosporine-ME (initial daily oral dose 7 mg/kg). All patients received 4 days of concomitant rATG induction therapy [ATG-Fresenius Biotech GmbH (ATG-F) daily dose of 4 mg/kg or Thymoglobulin-Genzyme/Sangstat (Thymo-S) 1.25 mg/kg], MMF (2 to 3 g per day), and short-term corticosteroids. RESULTS: Thymo-S was associated with a transiently lower white cell count in the first 3 months compared with ATG-F, while ATG-F caused a lower albeit transient early nadir in platelet count. Both polyclonal preparations were well tolerated; they did not differ with respect to clinically relevant side effects such as infections and malignancies. Higher cyclosporine-ME trough levels were associated with pancreas graft thrombosis. Study withdrawal was more frequent among patients on cyclosporine-ME therapy, because of toxicities, graft loss, and lack of efficacy, the last being the cause of subsequent switch to tacrolimus. Tacrolimus-treated patients were mainly withdrawn from the study due to MMF discontinuation. CONCLUSION: Short-term induction therapy in combined kidney-pancreas transplantation is effective and well tolerated. Tacrolimus causes fewer pancreas graft losses and fewer drug discontinuations due to side effects. When MMF is combined with tacrolimus, dose reductions and discontinuations are common.     

一种新型的大鼠胰肾联合移植模型的建立

目的建立一种简易、可靠的大鼠胰肾联合移植(SPK)模型。方法雄性SD大鼠作同品系异体移植的供受体,受体术前腹腔一次性注射链脲佐菌素(STZ)70mg/kg体重。采用供体右肾,移植物门静脉与肾下下腔静脉袖套式吻合,供受体肾上下腔-下腔、腹主-腹主两血管显微缝合;供体十二指肠与受体Treitz韧带下3~4cm的空肠侧侧吻合,移植物带输尿管的膀胱片与受体膀胱吻合,切除受体双肾。结果正式实验30例中手术成功率为90%(27/30),血管吻合时间30min,移植前血糖为(20.02±2.12)mmol/L,移植后24h血糖、肌酐即降为正常。结论此模型手术成功率高,术后并发症少,可进一步用于SPK的相关研究。     

Metabolic assessment after simultaneous pancreas-kidney transplantation

Simultaneous pancreas-kidney (SPK) transplantation has become a standard therapy for patients with type 1 diabetes and end-stage renal disease. We analyzed metabolic data in this clinical setting under tacrolimus- versus cyclosporine microemulsion (ME)-based immunosuppressive therapy. PATIENTS AND METHODS: We analyzed 205 patients enrolled in the Euro-SPK001 study for fasting blood glucose, fasting C peptide, glycated hemoglobin (HbA(1c)), blood lipids (total cholesterol and triglycerides), and pancreatic enzymes at regular intervals during the study. We compared blood pressure values with target levels for diabetic patients published by the European Society for Hypertension. RESULTS: Throughout the study, HbA(1c) and fasting C peptide levels were within the normal range in the two groups. Fasting blood glucose was higher during the first 2 months posttransplant in the tacrolimus group than in the cyclosporine-ME group, but no differences were seen thereafter. From month 2 posttransplant, mean levels of total cholesterol were significantly lower among patients receiving tacrolimus than those in the cyclosporine-ME group. In addition, patients receiving cyclosporine-ME showed serologic features of mild pancreatitis with elevated blood amylase and lipase levels during the first 6 months posttransplant. The two regimens were comparable with respect to hypertension, but target levels were reached in only 50% of the patients. CONCLUSION: Except for lipid profiles, no major differences in metabolic effects or blood pressure control were observed among SPK transplant patients receiving immunosuppression based on tacrolimus versus cyclosporine-ME. In view of the potential risk of hypertension, antihypertensive strategies should be implemented for all patients.     

Infectious complications after simultaneous pancreas-kidney transplantation

Simultaneous pancreas-kidney transplantation (SPKT) improves long-term survival of insulin-dependent diabetes mellitus patients with diabetic nephropathy. The increasing success of SPKT is a result of improved surgical technique, better organ preservation, potent antirejection therapy, and effective use of antibiotics to prevent and treat infectious complications. However, morbidity and mortality following SPKT remain high mainly owing to infection. From 1988 to 2004, the 51 patients who underwent SPKT were 32 women and 19 men of mean age 34 +/- 4 years old with diabetes and end-stage renal disease. The mean duration of diabetes mellitus was 23 +/- 4 years. The incidence of HCV and HBV infections were 19.6% and 13.7%, respectively. Preoperative work-up included identification and elimination prior to surgery of potential sources of infection. All patients prior to SPKTx had been treated by dialysis (26 +/- 20 months). The kidneys were always placed into the left retroperitoneal space first; at the same time the pancreatic grafts were prepared on the back table. The reconstruction of the superior mesenteric and the splenic arteries was performed using a Y graft of donor iliac artery to the common or external donor's iliac artery. The pancreas was transplanted intraperitoneally to the right iliac vessels. The portal vein was sutured to the common or external iliac vein and the arterial conduit of donor iliac artery. In 20 of the patients, bladder drainage and in 31, enteric drainage was used for the pancreatic juice exterioration. Patients received immunosuppression with a calcineurin inhibitor (tacrolimus or cyclosporin), mycophenolic acid or azathioprine, and steroids. Antibody induction (alternatively anti-IL-2 monoclonal antibody or ATG) was used in last 38 patients. Antibacterial (tazobactam) and antifungal (fluconazole) as well as antiviral (gancyclovir) prophylactic treatment was given to all patients for 7 to 10 days after transplantation. Thirty-eight recipients are alive, 26 with function of both grafts; 8 with functioning kidney grafts; and 4 with nonfunctioning grafts on dialysis treatment from 1 to 14 years after transplantation. Thirteen patients (24.5%) died during the first year after transplantation. Infectious complications were the main cause of death. Systemic infections accounted for the death of five patients and CNS infection for death of another five patients. Three patients died with functioning grafts due to cardiopulmonary disorders (myocardial infarction, pulmonary embolus) early in the postoperative period. A total of 102 infections were diagnosed in 51 patients during the posttransplant course. Twenty-one episodes of CMV infection (systemic 20, duodenal site 1), 73 bacterial infections (systemic 13, pulmonary 13, urinary tract 15, intestinal 8, wound 23), and 8 fungal infections (central nervous system 5, gastrointestinal tract 3). Some patients had more than one type of infection. Overall mortality in the investigated group was 24.5%. Infectious complications were the main cause of death (77%), including systemic infection (38.5%) and CNS infection (38.5%). The predominant etiology of the systemic infections was bacterial. The etiology of CNS infections was fungal. In conclusion, infectious complications are the main cause of morbidity and mortality following SPKT. The early diagnosis of infection, particularly fungal complications, is necessary. The administration of broad-spectrum prophylactic antibiotics, antifungal, and antiviral agents is recommended.     

Quality of life after simultaneous pancreas-kidney transplantation

Even recipients with satisfactory function of transplanted pancreas and kidney may show physical and/or social disability due to diabetic complications. Our aims were to evaluate diabetic complications influencing recipient quality of life and to assess patients' psychosociological status. Nineteen patients with functioning grafts who consented to take part in the study, underwent clinical evaluation and answered questions regarding their quality of life. Results showed excellent endocrine pancreatic function in 17 patients. In most recipients, insulin activity and C-peptide levels were elevated owing to systemic venous drainage. Opthalmological examination revealed blindness in 7 patients (in 4 cases with onset following SPKTx) and retinopathy in 13 patients (in 5 cases it appeared after SPKTx). Assessment of the cardiovascular system revealed satisfactory cardiac function in 16 of 19 patients; 4 patients underwent amputation of a lower limb following SPKTx. All 19 recipients admitted to a great benefit of transplantation; most patients declared ability to organize their life activity and social functions and 4 had regular employment. Conversely, most patients were afraid of graft loss, and half were often sad and even depressed.     

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。     

32例胰、肾同期联合移植的近期疗效

目的报告32例胰、肾同期联合移植(SPK)的近期结果及经验。方法为合并尿毒症的27例1型糖尿病和5例2型糖尿病患者施行SPK,其中胰液膀胱引流(BD)术式2例,改进的胰液空肠引流(ED)术式30例。术后早期采用他克莫司、霉酚酸酯及皮质激素预防排斥反应,同时以抗淋巴细胞球蛋白或抗CD25单克隆抗体诱导治疗。结果32例手术均获得成功,术后随访2～12个月,1例术后9周死于肺部感染,死亡时肾功能正常,另1例术后6个月死于急性心肌梗死,死亡时移植胰、肾功能正常,其余患者目前仍存活;术后(12.7±8.1)d空腹血糖恢复正常,(8.3±4.5)d停用胰岛素,(8.4±7.8)d血肌酐恢复正常。术后发生手术相关并发症有出血、移植胰切口感染、上消化道出血、右股静脉血栓形成和淋巴漏;其它并发症有药物不良反应、肺部感染,采用BD术式者并发代谢性酸中毒和镜下血尿;4例发生移植肾急性排斥反应,均经活检证实。结论SPK治疗糖尿病并发尿毒症的近期疗效满意,ED术式更符合正常生理。     

胰肾联合移植的外科技术探讨

目的 探讨胰液空肠引流式胰肾联合移植的外科技巧和临床应用.方法 中山大学附属第一医院2005年1月-2009年6月共施行了10例胰肾同期联合移植术(SPK),供体胰、十二指肠和肾均采用腹部多器官联合切取方式获得,经腹主动脉、肠系膜上静脉对胰腺及十二指肠同时快速灌注降温.移植胰的外分泌采用胰十二指肠一空肠内引流吻合方式.术后早期均以抗CD25单克隆抗体进行免疫诱导治疗,采用他克莫司、霉酚酸酯及皮质激素预防排斥反应.结果 10例移植手术均获得成功.供体胰十二指肠和肾的热缺血时间为(5.9±2.6)min;移植肾平均冷缺血时间为(5.2±2.2)h,移植胰平均冷缺血时间为(9.3±3.6)h.术后3例出现移植胰伤口感染,经治疗后3～12周愈合.2例出现胰十二指肠一空肠吻合口出血,均经保守治疗止血而治愈.未发生与胰液引流相关的外科并发症.1年内3例发生了急性排斥反应,2例经激素冲击和抗淋巴细胞球蛋白治疗而被逆转;1例顽固性急排患者术后39 d在持续肾脏替代治疗过程中并发脑血管意外死亡.其余9例均痊愈,随访6～12个月,完全停用胰岛素.结论 获取质量良好的供体器官及合理血管整形,是保证胰肾联合移植成功的前提;改进的胰液空肠外分泌引流术式的方法是可靠的.