R.P. Singh, J. Rogers, A.C. Farney, P.S. Moore, E.L. Hartmann, A. Reeves-Daniel, P.L. Adams, M. Gautreaux, R.J. Stratta

目标：在胰腺移植（PTX）中，有关扩大标准（EX）供体的数据还很有限。

方法：本研究对2007年2月至2007年4月期间进行同步肾胰联合移植（SKPT）的两组患者进行了回顾性分析：第一组患者为EX供体，即年龄<10或 ≥45岁，或者心脏死亡（DCD）后的尸供体；第二组患者为传统意义上的标准供体（CONV）。

结果：在79例SKPT患者中，19名患者（24%）的移植器官来自于EX供体（12例在45岁以上[平均50.2岁]、3例胰腺供体<10、4例为DCD供体），余下60例SKPT来自CONV供体。EX组供体的平均年龄高于CONV供体组（38 vs 25岁；P < .05）。两对照组在其他方面并无差别。在平均29 个月的随访中，EX组中患者、移植肾和移植胰的存活率分别为89%、89%和79%，CONV组中则分别为93%、87%和80% （P = NS）。两对照组在以下几方面情况相似：移植肾功能延迟恢复（每组均为5%）、因血栓形成造成早期移植胰功能丧失（EX组5%，CONV组8%）、急性排斥（EX组16%，CONV组18%）、手术并发症和感染等。1年中，EX组和CONV组患者的血清肌酐水平（每组均为1.4 mg/dL）或糖化血红蛋白水平（5.2% vs 5.5%）均没有明显差异。

结论：来自EX供体的SKPT患者的短期疗效与CONV供体组相似。年龄过大或DCD供体可能代表了SKPT中供体来源的不足。

Outcomes of Extended Donors in Pancreatic Transplantation With Portal-Enteric Drainage
R.P. Singh, J. Rogers, A.C. Farney, P.S. Moore, E.L. Hartmann, A. Reeves-Daniel, P.L. Adams, M. Gautreaux, R.J. Stratta

Objective: Limited data are available on extended (EX) donor criteria in pancreatic transplantation (PTX).

Methods: This retrospective study from February 2007 through April 2007 compared 2 cohorts of simultaneous kidney-pancreas transplantations (SKPT): the first from EX donors, which were defined as age <10 years or ≥45 years, or donation after cardiac death [DCD]), and the second from conventional (CONV) donors.

Results: Among 79 SKPT, 19 (24%) were from EX donors (12 older than age 45 [mean age, 50.2 years], 3 pediatric donors <10, and 4 DCD donors) and the remaining 60 SKPT from CONV donors. The mean donor age was higher in EX than CONV donors (38 vs 25 years, P < .05). There were no other differences between the 2 cohorts. With a similar median follow-up of 29 months, patient, kidney and pancreatic graft survival rates were 89%, 89%, and 79%, for the EX, whereas corresponding outcomes for CONV donors were 93%, 87%, and 80%, respectively (all P = NS). The incidences were similar for delayed kidney graft function (5% in each group), early pancreatic graft loss due to thrombosis (5% EX vs 8% CONV donors), acute rejection (16% EX vs 18% CONV donors), surgical complications, and infections. There were no significant differences in 1-year mean serum creatinine (1.4 mg/dL in each group) or glycohemoglobin (5.2% vs 5.5%) levels between the EX and CONV donor groups, respectively.

Conclusion: Short-term outcomes among SKPT from selected EX donors were comparable to CONV donors. Donors at the extremes of age and DCD donors may represent underused resources in SKPT.

Volume 40, Issue 2, Pages 502-505 (March 2008)

[责任编辑:刘 聪]