Zusammenfassung
Die Pankreastransplantation wird meistens in Kombination mit einer Nierentransplantation bei Typ-1-Diabetes-Patienten durchgeführt. Die Einjahres-/Zehnjahresüberlebensraten für die Simultantransplantation von Niere und Pankreas betragen laut internationaler Statistik und großen Studien für Patienten 94–100/79%, für die Nieren 89–92/63% und für die Pankreas 85–87/53%. Die hohe Erfolgsrate mit langfristiger Normalisierung des Glukosestoffwechsels führt nicht nur zu einer Stabilisierung oder Verbesserung der Sekundärkomplikationen, sondern auch zu einer signifikanten Senkung der Mortalität, die deutlich höher ist als bei alleiniger Nierentransplantation bei vergleichbaren Patienten. Die alleinige Pankreasverpflanzung bei noch guter Nierenfunktion bleibt einer strengen Indikationsliste vorbehalten. Die Inseltransplantation ist zwar weniger invasiv und zeigt geringere perioperative Risiken, weist aber schlechtere Ergebnisse in Bezug auf die langfristige Insulinunabhängigkeit auf. So zeigt sich eine Insulinunabhängigkeit nach einem Jahr bei nur 44% und nach 2 Jahren bei nur 13% der Patienten. Ein Teilerfolg mit Nachweis einer C-Peptid-Sekretion, Reduktion von HbA1c und Hypoglykämien ließ sich jedoch deutlich häufiger nachweisen.
Abstract
Pancreas grafting is mainly performed in combination with kidney transplantation in uremic type 1 diabetic patients. According to the international patient registry, patient 1-year/10-year survival rates following simultaneous kidney/pancreas transplantation is 94–100/79%, while for kidneys it is 89–92/63% and for the pancreas 85–87/53%. The high success rate with long-lasting normalization of glucose metabolism leads to a stabilization and/or amelioration of secondary complications and to a significant reduction in mortality, which is much higher when compared to that of kidney graft recipients with a comparable risk profile. Pancreas transplantation alone in patients with good kidney function or after successful renal grafting (living-related donation) requires special criteria. Islet grafting involves only a minor surgical procedure, but the short- and long-term results are poor compared to pancreas grafting. Insulin independence is found in 44% at 1 year and in 13% of patients at 3 years following islet transplantation. However, partial success with a detectable C-peptide secretion, improved glucose metabolism and a reduction in hypoglycemic events was found more frequently.
Abbreviations
- ADA:
-
Amerikanische Diabetes-Gesellschaft
- DDG:
-
Deutsche Diabetes-Gesellschaft
- DSO:
-
Deutsche Stiftung Organtransplantation
- IAK:
-
„Islet after kidney“ (Insel- nach Nierentransplantation)
- IPTR:
-
„International Pancreas Transplant Registry“
- ITA:
-
„Islet transplantation alone“ (singuläre Inseltransplantation)
- ITN:
-
„Immune Tolerance Network“
- KTA:
-
„Kidney transplantation alone“ (singuläre Nierentransplantation)
- LD-NTX:
-
„Living-donor-Nierentransplantation“ (Lebendspende Nierentransplantation)
- NTX:
-
Nierentransplantation
- PAK:
-
„Pancreas after kidney“ (Pankreas- nach Nierentransplantation)
- PTA:
-
„Pancreas transplantation alone“ (singuläre Pankreastransplantation)
- PTX:
-
Pankreastransplantation
- SPK:
-
„Simultaneous pancreas kidney“ (kombinierte Pankreas-Nieren-Transplantation)
- SIK:
-
„Simultaneous islet kidney“ (kombinierte Insel-Nieren-Transplantation)
- UNOS:
-
„United Network Organ Sharing“
Literatur
Ablorsu E, Ghazanfar A, Mehra S et al (2008) Outcome of pancreas transplantation in recipients older than 50 years: a single-centre experience. Transplantation 86:1511–1514
Arbogast H, Malaise J, Illner WD et al (2005) Rejection after simultaneous pancreas-kidney transplantation. Nephrol Dial Transplant 20 (Suppl 2):ii11–ii17, ii62
Becker BN, Brazy PC, Becker YT et al (2000) Simultaneous pancreas-kidney transplantation reduces excess mortality in type 1 diabetic patients with end-stage renal disease. Kidney Int 57:2129–2135
Brandhorst D, Brandhorst H, Hering BJ et al (1995) Islet isolation from the pancreas of large mammals and humans: 10 years of experience. Exp Clin Endocrinol Diabetes 103 (Suppl 2):3–14
Bretzel RG, Jahr H, Eckhard M et al (2007) Islet cell transplantation today. Langenbecks Arch Surg 392:239–253
Cheung AT, Perez RV, Chen PC (1999) Improvements in diabetic microangiopathy after successful simultaneous pancreas-kidney transplantation: a computer-assisted intravital microscopy study on the conjunctival microcirculation. Transplantation 68:927–932
Dieterle C, Brendel M, Seissler J et al (2006) Therapie des Diabetes mellitus. Internist 47:489–501
Dieterle CD, Arbogast H, Illner WD et al (2007) Metabolic follow-up after long-term pancreas graft survival. Eur J Endocrinol 156:603–610
Dieterle CD, Schmauss S, Arbogast H et al (2007) Pulmonary function in patients with type 1 diabetes before and after simultaneous pancreas and kidney transplantation. Transplantation 83:566–569
DSO (2008) http://www.dso.de/
Fioretto P, Steffes MW, Sutherland DE et al (1998) Reversal of lesions of diabetic nephropathy after pancreas transplantation. N Engl J Med 339:69–75
Fiorina P, Shapiro AM, Ricordi C et al (2008) The clinical impact of islet transplantation. Am J Transplant 8:1990–1997
Giannarelli R, Coppelli A, Sartini MS et al (2002) Early improvement of unstable diabetic retinopathy after solitary pancreas transplantation. Diabetes Care 25:2358–2359
Gruessner AC, Sutherland DE (2005) Pancreas transplant outcomes for United States (US) and non-US cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR) as of June 2004. Clin Transplant 19:433–455
Gruessner RW, Sutherland DE, Gruessner AC (2005) Survival after pancreas transplantation. JAMA 293:675; author reply 675–676
Gruessner RW, Sutherland DE, Kandaswamy R et al (2008) Over 500 solitary pancreas transplants in nonuremic patients with brittle diabetes mellitus. Transplantation 85:42–47
Koznarova R, Saudek F, Sosna T et al (2000) Beneficial effect of pancreas and kidney transplantation on advanced diabetic retinopathy. Cell Transplant 9:903–908
La Rocca E, Fiorina P, Carlo V di et al (2001) Cardiovascular outcomes after kidney-pancreas and kidney-alone transplantation. Kidney Int 60:1964–1971
Landgraf R (1996) Impact of pancreas transplantation on diabetic secondary complications and quality of life. Diabetologia 39:1415–1424
Larsen JL (2004) Pancreas transplantation: indications and consequences. Endocr Rev 25:919–946
McCullough KP, Keith DS, Meyer KH et al (2009) Kidney and pancreas transplantation in the United States, 1998–2007: access for patients with diabetes and end-stage renal disease. Am J Transplant 9:894–906
Morath C, Zeier M, Dohler B et al (2008) Metabolic control improves long-term renal allograft and patient survival in type 1 diabetes. J Am Soc Nephrol 19:1557–1563
Muller-Felber W, Landgraf R, Scheuer R et al (1993) Diabetic neuropathy 3 years after successful pancreas and kidney transplantation. Diabetes 42:1482–1486
Navarro X, Sutherland DE, Kennedy WR (1997) Long-term effects of pancreatic transplantation on diabetic neuropathy. Ann Neurol 42:727–736
Ojo AO, Meier-Kriesche HU, Hanson JA et al (2001) The impact of simultaneous pancreas-kidney transplantation on long-term patient survival. Transplantation 71:82–90
Piehlmeier W, Bullinger M, Kirchberger I et al (1996) Evaluation of the quality of life of patients with insulin-dependent diabetes mellitus before and after organ transplantation with the SF 36 health survey. Eur J Surg Oncol 162:933–940
Reddy KS, Stablein D, Taranto S et al (2003) Long-term survival following simultaneous kidney-pancreas transplantation versus kidney transplantation alone in patients with type 1 diabetes mellitus and renal failure. Am J Kidney Dis 41:464–470
Ryan EA, Paty BW, Senior PA et al (2005) Five-year follow-up after clinical islet transplantation. Diabetes 54:2060–2069
Scalea JR, Butler CC, Munivenkatappa RB et al (2008) Pancreas transplant alone as an independent risk factor for the development of renal failure: a retrospective study. Transplantation 86:1789–1794
Scheider A, Meyer-Schwickerath E, Nusser J et al (1991) Diabetic retinopathy and pancreas transplantation: a 3-year follow-up. Diabetologia 34 (Suppl 1):S95–S99
Shapiro AM, Lakey JR, Ryan EA et al (2000) Islet transplantation in seven patients with type 1 diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. N Engl J Med 343:230–238
Shapiro AM, Ricordi C, Hering BJ et al (2006) International trial of the Edmonton protocol for islet transplantation. N Engl J Med 355:1318–1330
Sindhi R, Stratta RJ, Lowell JA et al (1997) Experience with enteric conversion after pancreatic transplantation with bladder drainage. J Am Coll Surg 184:281–289
Sollinger HW, Odorico JS, Becker YT (2009) One thousand simultaneous pancreas-kidney transplants at a single center with 22-year follow-up. Ann Surg 250:618–630
Sureshkumar KK, Patel BM, Markatos A et al (2006) Quality of life after organ transplantation in type 1 diabetics with end-stage renal disease. Clin Transplant 20:19–25
Tyden G, Bolinder J, Solders G et al (1999) Improved survival in patients with insulin-dependent diabetes mellitus and end-stage diabetic nephropathy 10 years after combined pancreas and kidney transplantation. Transplantation 67:645–648
Venstrom JM, McBride MA, Rother KI et al (2003) Survival after pancreas transplantation in patients with diabetes and preserved kidney function. JAMA 290:2817–2823
Waki K, Terasaki PI (2006) Kidney graft and patient survival with and without a simultaneous pancreas utilizing contralateral kidneys from the same donor. Diabetes Care 29:1670–1672
Weimar B, Rauber K, Brendel MD et al (1999) Percutaneous transhepatic catheterization of the portal vein: A combined CT- and fluoroscopy-guided technique. Cardiovasc Intervent Radiol 22:342–344
Weiss AS, Smits G, Wiseman AC (2009) Twelve-month pancreas graft function significantly influences survival following simultaneous pancreas-kidney transplantation. Clin J Am Soc Nephrol 4:988–995
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Dieterle, C., Landgraf, R. Pankreas- und Inselzelltransplantation. Diabetologe 6, 51–64 (2010). https://doi.org/10.1007/s11428-009-0493-y
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DOI: https://doi.org/10.1007/s11428-009-0493-y
Schlüsselwörter
- Diabetes mellitus
- Pankreastransplantation
- Inseltransplantation
- Diabetische Folgekomplikationen
- Überleben