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。

Rejection in simultaneous pancreas-kidney transplantation

Objective To observe the rejection of simultaneous pancreas kidney transplantation (SPK) in 3 patients. Methods The immunosuppressive regimen consisted of FK506, MMF, Perid and Zenapax. Rejection was monitored by ultrasonography and determination of Cr, BUN and Glu. Patients who developed rejection were treated with steroid pulse or OKT3. Results The rejection rate was 66%. In rejection, the early manifertions of patients were unexplained fever, discomfort, sustained fall in urine volume, increased Cr, BUN, blood resistance of grafts, and then elevation of serum glucose. Conclusions Rejection in SPK is related with many factors. The kidney graft can provide protection to the pancreas graft. The ultrasonographic examination can be used to monitor the rejection of the grafts.