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DOI: 10.1055/s-2003-39461
Die simultane Pankreas- und Nierentransplantation - eine Chance für den Diabetiker mit Niereninsuffizienz
Simultaneous pancreas and kidney transplantation - a chance for diabetic patients with renal failurePublication History
eingereicht: 23.1.2003
akzeptiert: 17.4.2003
Publication Date:
28 May 2003 (online)

Erste Berichte über die Dialysetherapie bei Diabetikern zeigten extrem schlechte Ergebnisse. Ebenso waren erste Versuche der Nierentransplantation als Behandlungsmöglichkeit enttäuschend wegen ihrer hohen Empfängermortalität. In den 80er Jahren kam es zu einer Verbesserung des Patientenüberlebens. Dennoch blieb das Problem einer diabetischen Stoffwechsellage nach der Transplantation weiter bestehen. Die ersten Versuche, die simultane Pankreas- und Nierentransplantation als primäre Behandlungsmodalität einzuführen, waren mit schweren Komplikationen belastet. Erst nach einer langen Periode der Weiterentwicklung kann die simultane Pankreastransplantation heute als Routineprozedur für die meisten Fälle betrachtet werden.
Anhand von zwei Fallbeispielen soll demonstriert werden, welche Verbesserungen die Transplantationsbehandlung von Diabetikern inzwischen erreicht hat:
Literatur
- 1
Anonymus .
Actual
summary of data concerning patient-, graft- and donor characteristics,
risk factors and outcome as well as immunosuppression, surgical
details and number of transplants which are reported to the registry.
International
Pancreas Transplantation Registry Newsletter.
2000;
12
4-23
MissingFormLabel
- 2
Basadonna G, Matas A J, Najarian J S.
Kidney transplantation in diabetic patients:
the University of Minnesota experience.
Kidney Int Suppl.
1992;
38
S193-S196
MissingFormLabel
- 3
Battezzati A, Bonfatti D, Benedini S. et al .
Spontaneous hypoglycaemia after pancreas
transplantation in Type 1 diabetes mellitus.
Diabet Med.
1998;
15
991-996
MissingFormLabel
- 4
Becker B N, Brazy P C, Becker Y T. et al .
Simultaneous pancreas-kidney transplantation
reduces excess mortality in type 1 diabetic patients with end-stage
renal disease.
Kidney Int.
2000;
57
2129-2135
MissingFormLabel
- 5
Benedetti E, Najarian J S, Gruessner A C. et al .
Correlation between
cystoscopic biopsy results and hypoamylasuria in bladder-drained
pancreas transplants.
Surgery.
1995;
118
864-872
MissingFormLabel
- 6
Biesenbach G, Margreiter R, Konigsrainer A. et al .
Comparison of progression of macrovascular
diseases after kidney or pancreas and kidney transplantation in
diabetic patients with end-stage renal disease.
Diabetologia.
2000;
43
231-234
MissingFormLabel
- 7
Bilous R W, Mauer S M, Sutherland D E. et al .
The effects of pancreas
transplantation on the glomerular structure of renal allografts
in patients with insulin-dependent diabetes.
N Engl J
Med.
1989;
321
80-85
MissingFormLabel
- 8
Cook K, Sollinger H W, Warner T, Kamps D, Belzer F O.
Pancreaticocystostomy:
an alternative method for exocrine drainage of segmental pancreatic
allografts.
Transplantation.
1983;
35
634-636
MissingFormLabel
- 9
Douzdjian V, Rice J C, Gugliuzza K K, Fish J C, Carson R W.
Renal allograft and patient outcome
after transplantation: pancreas-kidney versus kidney-alone transplants
in type 1 diabetic patients versus kidney-alone transplants in nondiabetic
patients.
Am J Kidney Dis.
1996;
27
106-116
MissingFormLabel
- 10
Drachenberg C B, Papadimitriou J C, Klassen D K. et al .
Evaluation of
pancreas transplant needle biopsy: reproducibility and revision
of histologic grading system.
Transplantation.
1997;
63
1579-1586
MissingFormLabel
- 11
el-Gebely S, Hathaway D K, Elmer D S. et al .
An analysis of renal function
in pancreas-kidney and diabetic kidney-alone recipients at two years
following transplantation.
Transplantation.
1995;
59
1410-1415
MissingFormLabel
- 12
Farney A C, Cho E, Schweitzer E J. et al .
Simultaneous cadaver pancreas living-donor
kidney transplantation: A new approach for the type 1 diabetic uremic
patient (In Process Citation).
Ann Surg.
2000;
232
696-703
MissingFormLabel
- 13
Fioretto P, Steffes M W, Sutherland D E, Goetz F C, Mauer M.
Reversal of lesions of
diabetic nephropathy after pancreas transplantation.
N
Engl J Med.
1998;
339
69-75
MissingFormLabel
- 14
Gaber A O, el-Gebely S, Sugathan P. et al .
Early improvement in cardiac function occurs
for pancreas-kidney but not diabetic kidney-alone transplant recipients.
Transplantation.
1995;
59
1105-1112
MissingFormLabel
- 15
Gaber A O, Shokouh-Amiri M H, Hathaway D K. et al .
Results of pancreas transplantation
with portal venous and enteric drainage.
Ann Surg.
1995;
221
613-622
MissingFormLabel
- 16
Greger B, Koller M, Rothmund M.
Information
deficits and hesitant acceptance of combined pancreas-kidney transplantation
in Germany. A survey at German dialysis centers.
Dtsch
Med Wochenschr.
2002;
127
1375-1381
MissingFormLabel
- 17
Hurst G C, Somerville K T, Alloway R R, Gaber A O, Stratta R J.
Preliminary experience
with midodrine in kidney/pancreas transplant patients with orthostatic
hypotension.
Clin Transplant.
2000;
14
42-47
MissingFormLabel
- 18
Kahl A, Bechstein W O, Lorenz F. et al .
Long-term prednisolone withdrawal after
pancreas and kidney transplantation in patients treated with ATG,
tacrolimus, and mycophenolate mofetil.
Transplant Proc.
2001;
33
1694-1695
MissingFormLabel
- 19
Kahl A, Venz S, Keske U. et
al .
Magnetic resonance imaging and Levovist-enhanced
color and power Doppler imaging in the follow-up of pancreas transplants
in patients after combined pancreas and kidney transplantation.
Transplant
Proc.
1998;
30
246-247
MissingFormLabel
- 20
Kaufman D B, Leventhal J R, Stuart J. et al .
Mycophenolate mofetil and tacrolimus as
primary maintenance immunosuppression in simultaneous pancreas-kidney
transplantation: initial experience in 50 consecutive cases.
Transplantation.
1999;
67
586-593
MissingFormLabel
- 21
Land W, Malaise J, Sandberg J, Langrehr J.
Tacrolimus versus cyclosporine in
primary simultaneous pancreas-kidney transplantation: preliminary results
at 1 year of a large multicenter trial.
Transplant Proc.
2002;
34
1911-1912
MissingFormLabel
- 22
Lee C M, Scandling J D, Krieger N R, Dafoe D C, Alfrey E J.
Outcomes in diabetic patients
after simultaneous pancreas-kidney versus kidney alone transplantation.
Transplantation.
1997;
64
1288-1294
MissingFormLabel
- 23
Martin X, Petruzzo P, Dawahra M. et al .
Effects of portal versus systemic venous
drainage in kidney-pancreas recipients.
Transpl Int.
2000;
13
64-68
MissingFormLabel
- 24
Nankivell B J, Chapman J R, Bovington K J. et al .
Clinical determinants of glucose
homeostasis after pancreas transplantation.
Transplantation.
1996;
61
1705-1711
MissingFormLabel
- 25
Nankivell B J, Lau S G, Chapman J R. et al .
Progression of macrovascular
disease after transplantation.
Transplantation.
2000;
69
574-581
MissingFormLabel
- 26
Navarro X, Sutherland D E, Kennedy W R.
Long-term effects of pancreatic transplantation
on diabetic neuropathy.
Ann Neurol.
1997;
42
727-736
MissingFormLabel
- 27
Odorico J S, Pirsch J D, Knechtle S J, D’Alessandro A M, Sollinger H W.
A study
comparing mycophenolate mofetil to azathioprine in simultaneous pancreas-kidney
transplantation.
Transplantation.
1998;
66
1751-1759
MissingFormLabel
- 28
Rayhill S C, D’Alessandro A M, Odorico J S. et al .
Simultaneous pancreas-kidney
transplantation and living related donor renal transplantation in patients
with diabetes: is there a difference in survival?.
Ann
Surg.
2000;
231
417-423
MissingFormLabel
- 29
Robertson R P, Sutherland D E, Kendall D M. et al .
Metabolic characterization
of long-term successful pancreas transplants in type I diabetes.
J
Investig Med.
1996;
44
549-555
MissingFormLabel
- 30
Robertson R P, Sutherland D E, Lanz K J.
Normoglycemia and preserved insulin secretory
reserve in diabetic patients 10 - 18
years after pancreas transplantation.
Diabetes.
1999;
48
1737-1740
MissingFormLabel
- 31
Scheider A, Meyer-Schwickerath E, Nusser J, Land W, Landgraf R.
Diabetic
retinopathy and pancreas transplantation: a 3-year follow-up.
Diabetologia.
1991;
34
S95-S99
(Suppl 1)
MissingFormLabel
- 32
Schweitzer E J, Anderson L, Kuo P C. et al .
Safe pancreas transplantation in patients
with coronary artery disease.
Transplantation.
1997;
63
1294-1299
MissingFormLabel
- 33
Shapiro A M, Lakey J R, Ryan E A. et al .
Islet transplantation in
seven patients with type 1 diabetes mellitus using a glucocorticoid-free
immunosuppressive regimen.
N Engl J Med.
2000;
343
230-238
MissingFormLabel
- 34
Smets Y F, Westendorp R G, van der
Pijl J W. et al .
Effect
of simultaneous pancreas-kidney transplantation on mortality of
patients with type-1 diabetes mellitus and end-stage renal failure.
Lancet.
1999;
353
1915-1919
MissingFormLabel
- 35
Sollinger H W, Odorico J S, Knechtle S J. et al .
Experience with 500 simultaneous
pancreas-kidney transplants.
Ann Surg.
1998;
228
284-296
MissingFormLabel
- 36
Stratta R J.
Analysis
of mortality after pancreas transplantation.
Transplant
Proc.
1998;
30
283
MissingFormLabel
- 37
Stratta R J.
Review
of immunosuppressive usage in pancreas transplantation.
Clin
Transplant.
1999;
13
1-12
MissingFormLabel
- 38
Stratta R J, Larsen J L, Cushing K.
Pancreas
transplantation for diabetes mellitus.
Annu Rev Med.
1995;
46
281-298
MissingFormLabel
- 39
Stratton I M, Adler A I, Neil H A. et al .
Association of glycaemia
with macrovascular and microvascular complications of type 2 diabetes
(UKPDS 35): prospective observational study.
BMJ.
2000;
321
405-412
MissingFormLabel
- 40
Sugitani A, Egidi M F, Gritsch H A, Corry R J.
Serum
lipase as a marker for pancreatic allograft rejection.
Clin
Transplant.
1998;
12
224-227
MissingFormLabel
- 41
Trocha A K, Schmidtke C, Didjurgeit U. et al .
Effects of intensified antihypertensive
treatment in diabetic nephropathy: mortality and morbidity results
of a prospective controlled 10-year study.
J Hypertens.
1999;
17
1497-1503
MissingFormLabel
- 42
Tyden G, Reinholt F P, Sundkvist G, Bolinder J.
Recurrence of autoimmune diabetes
mellitus in recipients of cadaveric pancreatic grafts (see comments)
(published erratum appears in N Engl J Med 1996 Dec 5,335(23): 1778).
N
Engl J Med.
1996;
335
860-863
MissingFormLabel
- 43
Tyden G, Tollemar J, Bolinder J.
Combined
pancreas and kidney transplantation improves survival in patients
with end-stage diabetic nephropathy (In Process Citation).
Clin
Transplant.
2000;
14
505-508
MissingFormLabel
- 44
Wang Q, Klein R, Moss S E. et al .
The influence of combined kidney-pancreas
transplantation on the progression of diabetic retinopathy. A case series.
Ophthalmology.
1994;
101
1071-1076
MissingFormLabel
- 45
West M, Gruessner A C, Metrakos P, Sutherland D E, Gruessner R W.
Conversion from bladder to enteric
drainage after pancreaticoduodenal transplantations.
Surgery.
1998;
124
883-893
MissingFormLabel
- 46
Wolfe R A, Ashby V B, Milford E L. et al .
Comparison of mortality
in all patients on dialysis, patients on dialysis awaiting transplantation,
and recipients of a first cadaveric transplant.
N Engl
J Med.
1999;
341
1725-1730
MissingFormLabel
Prof. Ulrich Frei
Medizinische Klinik mit S. Nephrologie und Intern.
Intensivmedizin, Charité Campus Virchow-Klinikum
Augustenburger Platz 1
13353 Berlin
Phone: 030/450553132
Fax: 030/450553909
Email: ulrich.frei@charite.de