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目的:探讨胰肾联合移植术后急性排斥反应发生的影响因素及对预后的影响。方法:回顾性分析天津市第一中心医院2013年1月1日至2019年6月30日138例胰肾联合移植(SPK)受者，根据是否发生排斥反应分为排斥组27例和无排斥组111例，比较两组受者年龄、性别、体重指数(BMI)、糖尿病类型、糖尿病时间、透析时间、免疫诱导、供者年龄、人类白细胞抗原(HLA)错配、冷缺血时间、钙调神经磷酸酶抑制剂(CNI)药物种类、CNI药物浓度等因素，Logist回归多因素分析SPK术后急性排斥反应的危险因素。进一步分析急性排斥反应对移植物存活的影响。结果:27例(19.6%，27/138)受者共发生34次排斥反应，中位时间为术后3个月(0.6～18.0个月)。发生单纯移植肾排斥反应15例、单纯胰腺排斥反应1例，胰腺和肾脏同时发生排斥反应11例。单因素分析发现排斥反应组CNI药物浓度低的比例为55.6%(5/27)高于无排斥反应组的20.7%(23/111)(n P<0.001)。排斥反应组供者年龄(28.2±7.9)岁低于无排斥反应组的(31.8±8.6)岁(n P＝0.045)。多因素分析发现CNI药物浓度低(OR＝4.802，n P＝0.001)是急性排斥反应的独立危险因素。排斥反应组1年的移植肾、移植胰腺存活率分别为73.0%和73.6%，而无排斥反应组分别为100%和97.2%，差异有统计学意义(n P<0.001)。胰腺功能丧失组的胰腺急性排斥反应发生率高于胰腺存活组(40.0%比4.1%，n P<0.001)，胰腺功能丧失组受者BMI(25.8±3.9)kg/mn 2高于胰腺存活组的(23.6±3.3) kg/mn 2(n P＝0.016)。多因素分析发现SPK术后胰腺急性排斥反应(HR＝6.636，n P<0.001)和受者BMI(HR＝1.432、n P＝0.021)是影响移植胰腺功能丧失的独立危险因素。移植肾功能丧失组肾脏急性排斥反应发生率100%高于移植肾存活组的11.2%(n P<0.001)。n 结论:胰肾联合移植术后急性排斥反应发生率高，影响移植物预后，应加强术后早期急性排斥反应的诊治。“,”Objective:To explore the influencing factors of acute rejection after simultaneous pancreas-kidney transplantation (SPK).Methods:From January 1, 2013 to June 30, 2019, a total of 138 SPK recipients were divided into two groups of rejection (n=27) and non-rejection (n=111). Recipient/donor age, gender, body mass index (BMI), type/duration of diabetes, dialytic time, immune induction, HLA mismatch, cold ischemic time, type/concentration of calcinneurin inhibitor (CNI) drug and other factors were analyzed. Logistic regression multivariate analysis was performed for risk factors of acute rejection after SPK. The effects of acute rejection on graft survival were analyzed.Results:A total of 34 rejections occurred in 27 patients (19.6%, 27/138). The median time for rejection was 3(0.6-18) months. There were renal allograft rejection (n=15), simple pancreatic rejection (n=1) and pancreas-kidney rejection (n=11). Univariate analysis revealed that the proportion of a lower concentration of CNI drug was higher in rejection group than that in non-rejection group (55.6% vs. 20.7%, n P=0.001). The donor age of rejection group was lower than that of non-rejection group (28.2±7.9 vs. 31.8±8.6 years, n P=0.045). Logistic regression multivariate analysis indicated that a low CNI concentration (OR=4.802, n P=0.001) was an independent risk factor for acute rejection. The one-year graft kidney-pancreas survival rates were 73% and 73.6% in rejection group versus 100% and 97.2% in non-rejection group (n P=0.001). The incidence of acute pancreatic rejection was higher in pancreatic dysfunction group than that in pancreatic survival group (40.0% vs. 4.1%, n P=0.001). And recipient BMI was higher in pancreatic dysfunction group than that in pancreatic survival group (25.8±3.9 vs. 23.6±3.3, n P=0.016). Multivariate analysis revealed that acute pancreatic rejection (HR=6.636, n P=0.001) and recipient BMI (HR=1.432, n P=0.021) were two independent risk factors for pancreatic graft failure. The incidence of acute rejection was higher in renal allograft failure group than that in renal allograft survival group (100% vs. 11.2%, n P=0.001).n Conclusions:The incidence of acute rejection remains high after SPK transplantation. And timely diagnosis and prompt treatment of early acute rejection should be strengthened.