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目的总结7例胰肾一期联合移植治疗糖尿病肾病合并尿毒症的疗效。方法2005年1月至2008年9月我中心完成7例胰肾联合一期移植,采用空肠引流方式。免疫抑制治疗方案术后早期采⒚四联诱导方案:他克莫司(FK506)+霉酚酸酯(MMF)+甲基强的松龙(MP)+抗CD25单抗(赛尼哌或舒莱),后改为逐渐过渡至单⒚FK506维持治疗。结果回顾分析以上7例患者围手术期及长期随访情况:7例手术均获得成功,移植肾功能术后即刻恢复,6例患者术后第10天血糖降至正常水平,并完全停⒚外源性胰岛素。共发生急性排斥4例,除1例患者在连续肾脏替代疗法(CRRT)过程中并发心脑血管意外后家属放弃治疗外,其余3例患者经抗胸腺细胞球蛋白(ATG)+MP冲击治疗后移植肾功能均逆Κ恢复。早期的并发症包括伤口感染和出血。结论胰肾联合移植是治疗糖尿病合并终末期糖尿病肾病的有效方法。
Objective To summarize the curative effect of 7 cases of pancreas and kidney one combined transplantation on diabetic nephropathy with uremia. Methods From January 2005 to September 2008, 7 cases of pancreas-kidney combined with one-stage transplantation were completed in our center, using jejunal drainage. Immunosuppressive regimen Postoperative early quadruple induction program: tacrolimus (FK506) + mycophenolate mofetil (MMF) + methylprednisolone (MP) + anti-CD25 mAb Lai), later changed to a gradual transition to a single ⒚ FK506 maintenance treatment. Results The perioperative and long-term follow-up of the above 7 patients was retrospectively analyzed. All the 7 cases were successful in operation, and the function of renal allograft was recovered immediately after operation. The blood glucose of 6 patients dropped to normal level on the 10th day after operation and stopped completely Insulin. A total of 4 cases of acute rejection occurred in all but 3 of the 3 patients who were treated with ATG + MP after 1 case of concomitant cardiocerebral vascular accident (CRRT) with concomitant cardiocerebral injury. Transplant renal function are reversed Κ recovery. Early complications include wound infection and bleeding. Conclusion Combined pancreas and kidney transplantation is an effective method for the treatment of diabetic nephropathy with end-stage diabetes.