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目的探讨胰肾一期联合移植(SPK)术后免疫抑制药物的合理应用。方法 2005年1月至2009年6月我中心完成9例SPK,其中男5例,女4例,均采用空肠引流方式。术后采用IL-2单克隆抗体诱导的四联免疫抑制方案:IL-2单克隆抗体(舒莱或赛尼哌)+他克莫司(FK506)+霉酚酸酯(MMF)+激素,并逐渐过渡至单用FK506维持治疗。回顾性分析以上9例患者围术期及长期随访情况。结果 9例手术均获得成功。除1例早期死亡外,其余8例患者术后1周内肌酐降至正常水平,术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,共发生移植肾急性排斥4例,1例患者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(ATG)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。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,术后早期采用IL-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FK506维持治疗是安全的。
Objective To investigate the reasonable application of immunosuppressive drugs after pancreas-kidney transplantation (SPK). Methods From January 2005 to June 2009, 9 cases of SPK were completed in our center, including 5 males and 4 females, all of which were treated by jejunal drainage. IL-2 monoclonal antibody (Schleyer or daphnizone) + FK506 + mycophenolate mofetil (MMF) + hormone was induced by IL-2 monoclonal antibody after operation. And gradually transition to single FK506 maintenance treatment. Retrospective analysis of the above 9 patients perioperative and long-term follow-up. Results Nine cases were successful. Except one case of early death, creatinine was reduced to normal within one week after operation in the remaining eight patients. The duration of insulin withdrawal was (11.5 ± 3.5) days and the fasting blood glucose returned to normal ranged from (15.4 ± 6.3) days. Eight patients were followed up for 4 to 50 months. A total of 4 cases of acute graft rejection occurred. One patient underwent bedside hemodialysis with concomitant cardiovascular and cerebrovascular accident and the family members gave up treatment. The remaining three patients were treated with anti-thymocyte globulin (ATG) or steroid-induced renal allograft function reversed, and no allograft pancreas rejection was found during follow-up. Conclusions Combined pancreas and kidney transplantation is an effective method for the treatment of diabetic nephropathy with end-stage diabetes. It is safe to adopt the quadruple immunosuppressive regimen induced by IL-2 monoclonal antibody and gradually transition to maintenance therapy with FK506 alone.