R.P. Singh, J. Rogers, A.C. Farney, E.L. Hartmann, A. Reeves-Daniel, W. Doares, E. Ashcraft, P.L. Adams, R.J. Stratta

目标：分析胰肾联合移植（SKPT）时C肽持续表达的移植受体的疗效。

方法：这项回顾性分析的研究对象为2002年1月至2007年1月期间进行SKPT的患者，我们比较了C肽表达缺乏或C肽水平较低（<2.0 ng/mL，A组）的患者与C肽水平≥2.0 ng/mL（B组）患者的疗效。

结果：在74名SKPT患者中，67名患者在A组，其余7名患者在B组（平均C肽水平为5.7 ng/mL）。移植中，B组的患者年龄更大（平均51 vs 41岁，P = .006）、糖尿病的发病年龄更大（平均35 vs 13岁，P = .0001）、体重更重（平均77 vs 66 kg，P = .24）、非洲裔美国人所占比例更大（(57% vs 13%，P = .004）、术前透析时间也更长（平均40 vs 14 个月，P = .14）。在平均40个月的随访中，两组患者中移植肾（A组中为95%，B组为100%，P = NS）和移植胰（A组威尔诶87%，B组为100%，P = NS）的存活率相似，但是A组患者的存活率却高于B组（分别为94%和71%）。在1年的随访中，以下并发症在两组患者中没有出现明显不同：排斥反应、手术并发症、感染、重新入院治疗、糖化血红蛋白 A1C或C肽、血肌酐或MDRD GFR水平。

结论： 与进行SKPT的患者相比，移植前C肽水平恰当的糖尿病患者年龄更大、体重更重、更可能是非洲裔美国人、糖尿病的发病年龄更迟、移植前透析时间更长、患者存活率更低等。除此之外，其他的疗效均相似。

Do Pretransplant C-Peptide Levels Influence Outcomes in Simultaneous Kidney-Pancreas Transplantation
R.P. Singh, J. Rogers, A.C. Farney, E.L. Hartmann, A. Reeves-Daniel, W. Doares, E. Ashcraft, P.L. Adams, R.J. Stratta

Objective: To analyze outcomes in simultaneous kidney-pancreas transplantation (SKPT) recipients who retain C-peptide production at the time of SKPT.

Methods: This retrospective analysis of SKPTs from January 2002 through January 2007 compared outcomes between patients with absent or low C-peptide levels (<2.0 ng/mL, group A) with those having levels ≥2.0 ng/mL (group B).

Results: Among 74 SKPTs, 67 were in group A and seven in group B (mean C-peptide level 5.7 ng/mL). During transplantation, group B subjects were older (mean age 51 vs 41 years, P = .006); showed a later age of onset of diabetes (median 35 vs 13 years, P = .0001); weighed more (median 77 vs 66 kg, P = .24); had a greater proportion of African-Americans (57% vs 13%, P = .004); and had a longer pretransplant duration of dialysis (median 40 vs 14 months, P = .14). With similar median follow-up of 40 months, death-censored kidney (95% group A vs 100% group B, P = NS) and pancreas (87% group A vs 100% group B, P = NS) graft survival rates were similar, but patient survival (94% group A vs 71% group B, P = .03) was greater in group A. At 1-year follow-up, there were no significant differences in rejection episodes, surgical complications, infections, readmissions, hemoglobin A1C or C-peptide levels, serum creatinine, or MDRD GFR levels.

Conclusions: Diabetic patients with measurable C-peptide levels before transplant were older, overweight, more frequently African-American and had a later age of onset of diabetes, longer duration of pretransplant dialysis, and reduced patient survival compared to insulinopenic patients undergoing SKPT. The other outcomes were similar.

Volume 40, Issue 2, Pages 510-512 (March 2008)

[责任编辑:刘 聪]