Eş zamanlı böbrek ve pankreas naklinin son dönem böbrek yetmezliği ile birlikte olan diyabet tedavisindeki yeri: Olgu üzerinden tartışma ve yeni yaklaşımlar

Yıl 2016, Cilt: 1 Sayı: 1, 5 - 9, 01.02.2016

İlhami Soykan Barlas , Ebru Asmaz Ayşe Sinangil Ahmet Vedat Çelik Tevfik Ecder

Öz

Tip 1 diyabet, mikrovasküler ve makrovasküler komplikasyonlarla ilerleyen hastayı son dönem böbrek yetmezliğine götürebilen, pankreas adacık hücrelerinin kaybıyla karakterize otoimmün bir hastalıktır. Diyaliz ve insülin tedavisi, bu hastalara yaşama şansı tanırken, düşük yaşam kalitesi ve ilerleyici komplikasyonlar hastaları en çok zorlayan etkenlerdir. Eş zamanlı pankreas-böbrek nakli, bu grup hastada, hastanın yaşam kalitesini ve süresini artıran, normoglisemik kan düzeyiyle diyalizden bağımsız yaşamı sağlayan en önemli tedavi yöntemidir. Bu yazıda, eş zamanlı pankreas-böbrek nakli gerçekleştirilen bir olguyu, ameliyat tekniğini, tedavi sonuçlarını ve yeni yaklaşımları değerlendirdik.

Anahtar Kelimeler

Diyabet , eş zamanlı böbrek ve pankreas nakli , tedavi

Kaynakça

• Seyahi N, Altıparmak M, Ateş K, Trabulus S, Süleymanlar G. Türkiye’'de renal replasman tedavilerinin güncel durumu: Türk nefroloji derneği kayıt sistemi 2014 yılı özet raporu. Turk Neprh Dial Transp 2015;24(1):10-16.
• van der Boog, Ringers J, Paul LC, Jukema JW, Baranski A, Lemkes H, et al. Simultaneous kidney-pancreas transplantation: The preferred option for patients with type I diabetes mellitus and approaching end-stage renal disease. Transplant Rev 2004;18:129-38.
• Stadler M, Auinger M, Anderwald C, Kästenbauer T, Kramar R, Feinböck C, et al. Long-term mortality and incidence of renal dialysis and transplantation in type 1 diabetes mellitus. J Clin Endocrinol Metab 2006;91:3814-20.
• Sollinger HW, Odorico JS, Becker YT, D’Alessandro AM, Pirsch JD. One thousand simultaneous pancreas-kidney transplants at a single center with 22-year follow-up. Ann Surg 2009;250:618-30.
• Ojo AO, Meier-Kriesche HU, Hanson JA, Leichtman A, Magee JC, Cibrik D, et al. The impact of simultaneous pancreas-kidney transplantation on long-term patient survival. Transplantation 2001;71:82-90.
• Kelly WD, Lillehei RC, Merkel FK, Idezuki Y, Goetz FC. Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy. Surgery 1967;61:827-37.
• Perosa M, Boggi U, Cantarovich D, Robertson P. Pancreas transplantation outside the USA: an update. Curr Opin Organ Transplant 2011;16:135-41.
• Gruessner RW, Gruessner AC. The current state of pancreas transplantation. Nat Rev Endocrinol 2013;9:555-62.
• Reddy KS, Stablein D, Taranto S, Stratta RJ, Johnston TD, Waid TH, et al. Long-term survival following simultaneous kidney-pancreas transplantation versus kidney transplantation alone in patients with type 1 diabetes mellitus and renal failure. Am J Kidney Dis 2003;41:464-70.
• Sollinger HW, Odorico JS, Knechtle SJ, D'Alessandro AM, Kalayoglu M, Pirsch JD. Experience with 500 simultaneous pancreas-kidney transplants. Ann Surg 1998;228:284-96.
• Gaber AO, Shokouh-Amiri H, Grewal HP, Britt LG. A technique for portal pancreatic transplantation with enteric drainage. Surg Gynecol Obstet 1993;177:417-9.
• Stratta RJ, Shokouh-Amiri MH, Egidi MF, Grewal HP, Kizilisik AT, Nezakatgoo N, et al. A prospective comparison of simultaneous kidney-pancreas transplantation with systemic-enteric versus portal-enteric drainage. Ann Surg 2001;233:740-51.
• Spetzler VN, Goldaracena N, Marquez MA, Singh SK, Norgate A, McGilvray ID, et al. Duodenal leaks after pancreas transplantation with enteric drainage - characteristics and risk factors. Transpl Int 2015;28:720-8.
• McCullough KP, Keith DS, Meyer KH, Stock PG, Brayman KL, Leichtman AB. Kidney and pancreas transplantation in the United States, 1998-2007: access for patients with diabetes and end-stage renal disease. Am J Transplant 2009;9:894-906.
• Meier-Kriesche HU, Ojo AO, Port FK, Arndorfer JA, Cibrik DM, Kaplan B. Survival improvement among patients with end-stage renal disease: trends over time for transplant recipients and wait-listed patients. J Am Soc Nephrol 2001;12:1293-6.
• Smith GC, Trauer T, Kerr PG, Chadban SJ. Prospective quality-of-life monitoring of simultaneous pancreas and kidney transplant recipients using the 36-item short form health survey. Am J Kidney Dis 2010;55:698-707.
• Mora M, Ricart MJ, Casamitjana R, Astudillo E, López I, Jiménez A, et al. Pancreas and kidney transplantation: long- term endocrine function. Clin Transplant 2010;24:236-40.
• Pearce IA, Ilango B, Sells RA, Wong D. Stabilisation of diabetic retinopathy following simultaneous pancreas and kidney transplant. Br J Ophthalmol 2000;84:736-40.
• Chow VC, Pai RP, Chapman JR, O’Connell PJ, Allen RD, Mitchell P, et al. Diabetic retinopathy after combined kidney-pancreas transplantation. Clin Transplant 1999;13:356-62.
• Fioretto P, Steffes MW, Sutherland DE, Goetz FC, Mauer M. Reversal of lesions of diabetic nephropathy after pancreas transplantation. N Engl J Med 1998;339:69-75.
• Niederhaus SV, Kaufman DB, Odorico JS. Induction therapy in pancreas transplantation. Transpl Int 2013;26:704-14.
• Ollinger R, Margreiter C, Bösmüller C, Weissenbacher A, Frank F, Schneeberger S, et al. Evolution of pancreas transplantation: long-term results and perspectives from a high-volume center. Ann Surg 2012;256:780-6.
• Mulgaonkar S, Kaufman DB. Conversion from calcineurin inhibitor-based immunosuppression to mammalian target of rapamycin inhibitors or belatacept in renal transplant recipients. Clin Transplant 2014;28:1209-24.
• Freise CE, Stock PG, Melzer JS. Increased morbidity and mortality of simultaneous pancreas-renal transplantation in patients over 49 years of age. Transplant Proc 1998;30:292.
• Siskind E, Maloney C, Akerman M, Alex A, Ashburn S, Barlow M, et al. An analysis of pancreas transplantation outcomes based on age groupings--an update of the UNOS database. Clin Transplant 2014;28:990-4.
• Israni AK, Skeans MA, Gustafson SK, Schnitzler MA, Wainright JL, Carrico RJ, et al. OPTN/SRTR 2012 Annual Data Report: pancreas. Am J Transplant 2014;14:45-68.
• Gruessner AC. 2011 update on pancreas transplantation: comprehensive trend analysis of 25,000 cases followed up over the course of twenty-four years at the International Pancreas Transplant Registry (IPTR). Rev Diabet Stud 2011;8:6-16.
• Light JA, Barhyte DY. Simultaneous pancreas-kidney transplants in type I and type II diabetic patients with end- stage renal disease: similar 10-year outcomes. Transplant Proc 2005;37:1283-4.
• Wiseman AC, Gralla J. Simultaneous pancreas kidney transplant versus other kidney transplant options in patients with type 2 diabetes. Clin J Am Soc Nephrol 2012;7:656-64.