特集「各臓器移植における長期成績とその問題点」
膵臓移植の長期成績向上に向けて～膵グラフト生着に影響を及ぼす因子の検討
2016 年 51 巻 4-5 号 p. 355-370
詳細
2016 年 51 巻 4-5 号 p. 355-370
The aim of the present study was to reveal the long-term outcomes of pancreas transplantation and to elucidate the risk factors that affect pancreatic graft survival in Japan.
We retrospectively analyzed a total of 246 cases of pancreas transplantation. After the exclusion of cases involving graft loss resulting from perioperative complications, the cases of 233 patients who underwent pancreas transplantation were divided into two groups: the simultaneous pancreas and kidney transplantation (SPK) group (n=188) and the pancreas transplantation after kidney and pancreas transplantation alone (PT) group (n=45) ; each group was analyzed to determine the factors associated with pancreatic graft survival.
The pancreatic graft survival rates at 1, 5, and 10 years after transplantation were 86.8%, 82.9%, and 74.9%, respectively, in the cases of SPK; and 85.1%, 42.2%, and 31.7%, respectively, in the cases of pancreas transplantation after kidney and pancreas transplantation alone, which amounted to a significant difference （P=4.81×10‐5）. Episodes of rejection made pancreatic survival significantly lower in both groups. A multivariate analysis using Cox proportional hazards regression revealed that the preoperative period of diabetes （hazard ratio, 1.065; 95%CI, 1.009-1.125; P=0.02341） was significantly associated with pancreatic graft survival in the SPK group. HLA-A mismatch （hazard ratio, 2.153; 95%CI, 1.073-4.321; P= 0.03101） was the only factor associated with pancreatic graft survival in the PT group. Although the difference did not reach statistical significance, it was suggested that induction therapy with a T-cell depleting antibody would improve the rate of pancreatic graft survival in both groups.
In spite of the severe shortage of donors in Japan, simultaneous pancreas and kidney transplantation should be performed for type 1 diabetes patients with end-stage renal failure in the earlier stage, and HLA-A matching should be considered when selecting recipients to improve the rate of pancreatic graft survival in the PT group.
