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Simultaneous pancreas-kidney transplantation with modified enteric drainage of exocrine pancreatic secretion

查看全文 作　　者：Bin Liu, Chang-Sheng Ming, Fan-Jun Zeng, Bo Sha, Zhi-Shui Chen, Zhong-Hua Chen and Shi Chen Wuhan, China Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030 , China 高影响力作者 出　　处：《Hepatobiliary & Pancreatic Diseases International》索引2004年第3卷第2期,共5页高影响力期刊 摘　　要：BACKGROUND: As a valid therapeutic option for patients with type 1 diabetes mellitus (IDDM) and secondary dia- betic nephropathy, simultaneous pancreas-kidney trans- plantation (SPK) remains more undeveloped than other solid organ transplantations due to the restrictions of surgi- cal techniques especially the modes of exocrine pancreatic secretion. The aim of this paper was to summarize our sin- gle-center experience in SPK with modified enteric drai- nage (ED). METHODS: From June 2000 to July 2003, 10 patients with IDDM associated with uremia received SPK. The pancrea- tic allograft exocrine secretion was drained into the proxi- mal jejunum via a side-to-side duodenojejunostomy with- out Roux-en-Y anastomosis. Quadruple immunosuppres- sive regimen consisted of induction of tacrolimus (TAC) / cyclosporine (CsA), mycophenolate mofetil (MMF), ste- roids and antibodies, which included antilymphocyte glo- bulin (ALG) or anti-CD25 monoclonal antibody. RESULTS: ED-SPK without Roux-en-Y anastomosis was successful in all 10 patients without serious complications such as pancreatitis, graft thrombosis and pancreatic fistu- la. The patients regained immediate kidney allograft func- tion and euglycemia with insulin-independence. Four pa- tients survived over one year. Episodes of acute rejection were observed in 4 patients, 3 of whom showed reversion after treatment of OKT3 or insulin. Early postoperative complications included peritoneal infection ( 2 patients ), wound infection (2) and renal hematoma (1). CONCLUSION: ED-SPK without Roux-en-Y anastomosis is safe and preferable to the patients with IDDM associated with uremia. 关 键 词：PANCREAS KIDNEY TRANSPLANTATION DIABETES
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