Animal Experiment And Clinical Application Of Simultaneous Pancreas-Kidney Transplantation

ObjectiveTo master the technique for simultaneous procurement of the kidney,pancreas,duodenum and spleen through animals experiment and grasp the skill for preparation and transplantation of pancreas and kidney. The above techniques were utilized in clinical. The immunosuppression perioperation and the prevention for complication after transplantation were studied to offer evidence for development of internal SPK. Methods1. Using pigs as object,Symphysial incised donor's pancreas,duodenum,kidney and spleen after in situ cooling through abdominal aorta. Then,prepared the pancreas,kidney for SPK witch had bladder drainage of exocrine secretion. The urine amylase were monitoted after operation.2. The uremic diabetic patient,who can withtand surgery and immunosuppression,was performed SPK and received tolerance-inducing,maintenance immunosuppression. Prevention treatments for infection,bleeding,venous thrombosis prophylaxis by heparinization and assistance of the recovery of the pancreatic function by exogenous insulin were utilized after operation. The fasting blood glucose,serum creatinine,APTT,TT,PT,HCT,plasma and urine amylase,fasting insulin and c-peptide,trough level of FK506 and lymph cells were supervised after operation.Results1. Anmals experiment:The pancreas and kidney allgrafts were no heat ischemia and recovered urine,exocrine secretion immediately aftertransplantation. Urine amylase elevated at once and maintained its levels until the pig was died 34 hours after operation witch caused by rejection episodes and metabolic disturbance.2. clinical studies:Heat ischemia time of the pancreas and kidney allografts was less than 5min. The functions of kidney allograft recovered gradually within a week after transplantation and serum creatinine declined to 113umol/l. However,it was damaged later by excessive FK506. Hemodialysis and reduced dose of FK506 regained the normal kidney allograft function finally.Plama and urine amylase decreased and maintained normal levels quickly after operation. The fasting blood glucose kept the normal levels without exogenous insulin injections finally. The glycosylated haemoglobin Al lowered to 5.8% one month after transplantation. Under the using of heparinization,APTT,PT and TT were maintained at superior limit of the normal level and no thrombosis occurred. No surgical complications occurred after transplantation.Conclusions1. Spk is operative treatments to patients with insulin- dependent diabetes mellitus and end-stage renal disease.2. The treatment of symphysial incised donor's pancreas,duodenum,kidney and spleen after in situ cooling through abdominal aorta can avoid injury of pancreas.3. Tolerance-inducing by Daclizumab and ATG,Tac-MMF-based immunosupression can fewer acute rejection episodes in SPK.4. Early treatment by insulin is favor of the recovery of the pancreatic function.5. The early treatment of heparinization can decreased thrombosis of transplanted pancreas.