P. Schenker, A. Wunsch, N. Ertas, M. Schaeffer, L.C. Rump, R. Viebahn, O. Vonend

简介：由于器官捐献的不足，临床上迫切需要使用一切可用的胰腺供体来为患者进行移植手术。

方法：在1994年6月至2006年12月期间，我们共进行了340例胰腺移植手术（317例为胰肾同步联合移植，仅5例为单纯胰腺移植，18例为肾移植后胰腺移植），其中69例（20%）移植的供体年龄达到了45岁或45岁以上。对于这些供体年龄较大的胰腺移植，我们分别分析了移植物存活率、患者存活率以及术后并发症的发病情况，并将以上结果与年轻供体的胰腺移植进行了对比。

结果：我们对两组受体的特征进行了对比。大龄组供体的平均年龄在47.8（±2.1）岁，年轻组供体则为27.9（±10.3）岁。累计患者存活率在第1年分别为96%和98%，第5年为82%和91%，第10年为82%和88%；在第1年、第5年以及第10年两组患者的移植肾存活率分别为82%、72%、57% 和93%、83%、73%。在第1年、第5年以及第10年大龄组和年轻组患者的移植胰存活率则分别为69%、60%、45%和88%、76%、72%。大龄组中有14名患者（20%）出现了静脉血栓形成，年轻组中则为25例（9%）(P = .012)。

结论：我们的研究结果证明，在胰肾同步联合移植中使用45岁或45岁以上供体捐赠的胰腺所取得的疗效还是可以接受的，这样也可以扩大器官捐赠的来源。在大龄供体组中，患者的存活率稍微低于年轻组，移植胰功能也明显劣于年轻组（P < .01）。由于静脉血栓形成是导致大龄组受体移植胰损伤的主要原因，所以对患者进行抗凝治疗是必不可少的。

Long-Term Results After Simultaneous Pancreas-Kidney Transplantation Using Donors Aged 45 Years or Older
P. Schenker, A. Wunsch, N. Ertas, M. Schaeffer, L.C. Rump, R. Viebahn, O. Vonend

Abstract: With the shortage of organ donors, there is a critical need to use all available pancreas grafts for transplantation.

Methods: From June 1994 to December 2006 we performed 340 pancreas transplantations (317 simultaneous pancreas-kidney 5 pancreas only, 18 pancreas after kidney) including 69 (20%) transplantations from donors aged 45 years or older. Pancreas grafts from older donors were analyzed for graft and patient survival as well as surgical complications, compared with results from younger donors.

Results: Recipient characteristics were comparable in both groups. The older donor group mean age was 47.8 years (±2.1) versus 27.9 years (±10.3) for the younger group. Cumulative patient survival was 96% versus 98% after 1, 82% versus 91% after 5 and 82% versus 88% after 10 years with 1–5- and 10-year kidney graft survivals of 82%, 72%, 57% versus 93%, 83%, 73%, respectively. Pancreas transplant survival after 1, 5, and 10 years were 69%, 60%, 45% in older and 88%, 76%, and 72% in younger donor cohorts. There were 14 (20%) cases of venous thrombosis in the older group and 25 (9%) in the younger group (P = .012).

Conclusion: Our results demonstrated that utilization of pancreas grafts from donors over 45 years resulted in acceptable outcomes after simultaneous pancreas-kidney transplant and could expand the donor pool. Among the older donor group, patient survival was slightly lower than the younger group, whereas pancreas graft function was significantly inferior (P < .01). Since venous thrombosis was the main reason for pancreas graft loss in older group, anticoagulation is essential.

Volume 40, Issue 4, Pages 923-926 (May 2008)

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