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Pankreas- und Inselzelltransplantation

Pancreas and islet cell transplantation

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Der Diabetologe Aims and scope

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.

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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“

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  1. Schwerpunktpraxis Diabetologie und Endokrinologie, Ärztehaus Harlaching, München, Isenschmidstr. 19, 81545, München, Deutschland

    C. Dieterle

  2. Deutsche Diabetes-Stiftung, München, München, Deutschland

    R. Landgraf

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  1. C. Dieterle
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  2. R. Landgraf
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Correspondence to C. Dieterle.

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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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