What We Do and Donʼt Understand About Pancreas Graft Failure.: Abstract# B1301
Transplantation(2014)
摘要
The purpose of this study was to analyze patterns of graft failure (GF) following pancreas transplantation (PT) in an attempt to develop a better understanding of GF. Methods: We retrospectively reviewed outcomes in 202 consecutive PTs in 192 patients at our center; all were insulin-requiring pretransplant and received either r-ATG or alemtuzumab induction with tacrolimus/mycophenolate ± steroids. GF was defined as a return to daily scheduled exogenous insulin therapy irrespective of dose. Results: From 11/01 to 3/13, we performed 162 simultaneous pancreas-kidney transplants (SPKT) and 40 solitary PTs. In the SPKT group, 51 patients had measurable pretransplant C-peptide levels. With a mean follow-up of 6 years, 76 (37.6%) pancreas GFs occurred including 20 deaths with functioning grafts (DWFG). The death-censored pancreas graft failure rate was 30.8%; of these 56 pancreas GFs, 20 occurred early (within 3 months of PT) and 36 occurred late. Rates of early thrombosis were 8% in SPKT and 5% in solitary PT patients. Death-censored causes of pancreas GF were acute/chronic rejection (34), thrombosis (18), infection (3) and one primary nonfunction. Allograft pancreatectomy (AP) was performed in 22 cases; rates of AP were 95% for early (<3 months) and 11.8% for late pancreas GF (p<0.001). After excluding DWFGs and pancreas GFs that resulted in AP, a total of 36 pancreas GFs remained, 10 of which did not have C-peptide data at the time of pancreas GF. Of the remaining 26 pancreas GFs, 13 occurred in patients who were C-peptide positive (mean pretransplant C-peptide level 5.7 ng/ml). In these 13 cases, the mean C-peptide level at the time of pancreas GF (insulin resumption) was 3.3 ng/ml (range 0.9-7.9). In all but one case, the C-peptide level at the time of pancreas GF was less than the pretransplant C-peptide level. Of 13 pancreas GFs in pretransplant C-peptide negative patients, the mean C-peptide level at the time of pancreas GF was 1.5 ng/ml (range 0-3.8); 5 had C-peptide levels ≥2.0, 4 had C-peptide levels 1-2, and 4 had C-peptide levels <1.0 ng/ml. Conclusions: DWFG and AP account for more than half of cases of pancreas GF. Of the remaining cases of GF (defined as loss of insulin independence), C-peptide levels appear to be of limited predictive value whether or not the patient had detectable C-peptide levels pretransplant.
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关键词
pancreas graft failure
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