臨牀透析 Vol.21 No.1(6)


特集名 糖尿病と透析療法
題名 膵腎同時移植
発刊年月 2005年 01月
著者 石橋 道男 膵臓移植中央調整委員会・実務者委員会委員長/奈良県立医科大学泌尿器科
【 要旨 】 膵腎同時移植は,1型糖尿病で腎不全となった患者のQOLを高め,生命予後を改善する移植医療である.欧米の成績は,患者1年生存率は96%,膵臓の1年生着率は約85%,腎臓は約90%である.わが国ではこれまで17例が実施され,患者1年生存率は100%,膵臓の1年生着率は94%,腎臓は100%と良好である.膵腎同時移植術では,“外科的合併症”を減らすことが課題となっているが,これに対し,わが国では,ドナー膵臓グラフトの十二指腸膵頭部への血流を胃十二指腸動脈の温存あるいは再建し,虚血障害を回避する術式を当初から採用していることで“外科的合併症”を少なくし,良好な結果になっている可能性がある.
Theme Dialysis in Diabetic Patients
Title Simultaneous pancreas and kidney transplantation
Author Michio Ishibashi Department of Urology, Nara Medical University
[ Summary ] Simultaneous pancreas and kidney transplantation, SPK is indicated for type 1 diabetic patients with renal failure. SPK is an effective therapy that augments quality of life for recovery of a more normal life style, without insulin therapy or dialysis treatment. SPK ameliorates diabetic neuropathy with few autonomic complication, and stabilizes retinopathy. There was a statistics from the International Pancreas Registry indicate that 1-year patient survival rate was 96%, pancreas 1-year graft survival was 85%, and kidney 1-year graft survival rate was 90%. In Japan, 17 cases of pancreas and kidney transplantation, 15 cases of SPK and two cases of PAK, pancreas after kidney transplantation were performed up to September 2004. In these cases, all patients were alive at that time ; with 94% of pancreas 1-year graft survival rate and 100% of 1-year kidney graft survival rate was observed. To improve the efficacy of SPK, surgical complications as “Technical Failure” should be minimized. In Japanese series, the modified surgical procedure of vascular reconstruction of the gastroduodenal artery to the pancreas allograft has been employed, which allows us to keep the vascular supply for the pancreatic head and duodenum and results avoiding ischemia injury in most cases.
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