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背景:胰肾联合移植已经被公认为是糖尿病(包括1型和2型)合并终末期尿毒症的有效治疗手段,由于胰腺为高免疫原性器官,合理的免疫抑制治疗是保证胰腺移植成功的关键。目的:探讨胰肾一期联合移植后免疫抑制药物的合理应用。方法:纳入2005-01/2009-06在中山大学附属第一医院器官移植中心完成胰肾一期联合移植的患者9例,其中男5例,女4例,胰液引流均采用空肠引流方式。术后采用白细胞介素2单克隆抗体诱导的四联免疫抑制方案:白细胞介素2单克隆抗体+他克莫司+麦考酚酸+激素,并逐渐过渡至单用他克莫司维持治疗。回顾性分析以上9例患者围手术期及长期随访情况。结果与结论:胰肾一期联合移植后,除1例早期死亡外,其余8例患者移植后1周内肌酐降至正常水平,移植后停用胰岛素时间为(11.5±3.5)d,空腹血糖恢复至正常时间为(15.4±6.3)d。8例患者随访4～50个月期间,共有4例发生移植肾急性排斥,其中1例在接受床边血液透析过程中并发心脑血管意外后家属放弃治疗,其余3例患者经抗胸腺细胞球蛋白或激素冲击治疗后移植肾功能均逆转恢复,随访过程中未发现移植胰腺排斥。说明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,术后早期采用白细胞介素2单克隆抗体诱导的四联免疫抑制方案并逐渐过渡至单用他克莫司维持治疗是安全的。
BACKGROUND: Combined pancreas-kidney transplantation has been recognized as an effective treatment for diabetes mellitus (including type 1 and type 2) with end-stage uremia. Since the pancreas is a highly immunogenic organ, reasonable immunosuppressive therapy is the key to successful pancreas transplantation . Objective: To explore the rational use of immunosuppressive drugs after pancreas and kidney transplantation. Methods: Nine patients (including 5 males and 4 females) who underwent combined pancreas and kidney transplantation in the First Affiliated Hospital of Sun Yat-sen University from January 2005 to June 2009 were enrolled in this study. The drainage of pancreatic juice was performed by jejunal drainage. Postoperative use of interleukin 2 monoclonal antibody-induced quadruple immunosuppression program: interleukin 2 monoclonal antibody + tacrolimus + mycophenolic acid + hormone, and gradually transition to a single treatment with tacrolimus maintenance . Retrospective analysis of the above 9 patients perioperative and long-term follow-up. RESULTS AND CONCLUSION: In the first phase of pancreas and kidney transplantation, except for one case of early death, creatinine was reduced to normal within 1 week after transplantation in the remaining 8 cases. Insulin time after transplantation was (11.5 ± 3.5) d, fasting blood glucose Recovery time to normal was (15.4 ± 6.3) d. A total of 4 patients with acute renal allograft rejection occurred in 8 patients during the follow-up period of 4 to 50 months. One of the 8 patients underwent bedside hemodialysis and their family members gave up their treatment after the accidental cardiovascular and cerebrovascular accident. The remaining 3 patients were treated with anti-thymocyte Transplanted renal function recovered after protein or hormone shock treatment, and no allograft pancreas rejection was found during follow-up. Combined pancreas and kidney transplantation is an effective method for the treatment of diabetic patients with end stage diabetic nephropathy. The early postoperative use of interleukin 2 monoclonal antibody-induced quadruple immunosuppressive regimen and the gradual transition to monotherapy with tacrolimus is safe .