BACKGROUND In contrast to insulin-dependent type 1 diabetes mellitus (T1DM), the indication for Simultaneous pancreas-kidney transplantation (SPK) in patients with type 2 diabetes mellitus (T2DM) is still ambiguous and wisely Eurotransplant (ET) only granted transplant-permission in a selected group of patients. However, with regard to improvement of metabolic conditions SPK might still be a considerable treatment option for lean insulin dependent type 2 diabetics suffering from renal disease. METHODS Medical data (2001-2013) from all consecutive T1DM and T2DM patients who received a SPK or kidney transplant alone (KTA) at the University Hospital of Leipzig were analyzed. Donor, recipients and long-term endocrine, metabolic and graft outcomes were investigated for T1DM and T2DM-SPK recipients (transplanted upon a special request allocation by ET) and T2DM patients who received a KTA during the same period. RESULTS Eighty nine T1DM and 12 T2DM patients received a SPK and 26 T2DM patients received a KTA. Patient survival at 1 and 5 years was 89.9 and 88.8% for the T1DM group, 91.7 and 83.3% for the T2DM group, and 92.3 and 69.2% for the T2DM KTA group, respectively (p < 0.01). Actuarial pancreas graft survival for SPK recipients at 1 and 5 years was 83.1 and 78.7% for the T1DM group and 91.7 and 83.3% for the T2DM group, respectively (p = 0.71). Kidney allograft survival at 5 years was 79.8% for T1DM, 83.3% for T2DM, and 65.4% for T2DM KTA (p < 0.01). Delayed graft function (DGF) rate was significantly higher in type 2 diabetics received a KTA. Surgical, immunological and infectious complications showed similar results for T1DM and T2DM recipients after SPK transplant and KTA, respectively. With regard to the lipid profile, the mean high-density lipoprotein (HDL)- cholesterol levels were significantly higher in T1DM recipients compared to T2DM patients before transplantation (p = 0.02) and remained significantly during follow up period. CONCLUSION Our data demonstrate that with regard to metabolic function a selected group of patients with T2DM benefit from SPK transplantation. Consensus guidelines and further studies for SPK transplant indications in T2DM patients are still warranted.

中文翻译：

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1型和2型糖尿病患者同时接受异体胰肾移植的短期和长期代谢结果。

背景技术与胰岛素依赖型1型糖尿病（T1DM）相比，在2型糖尿病（T2DM）患者中同时进行胰肾移植（SPK）的适应症仍然模棱两可，而明智的做法是Eurotransplant（ET）仅允许移植在选定的一组患者中。然而，对于改善代谢状况，对于患有肾脏疾病的瘦型胰岛素依赖型2型糖尿病患者，SPK可能仍然是一个重要的治疗选择。方法分析了来自莱比锡大学医院的所有连续接受SPK或肾脏移植手术（KTA）的连续T1DM和T2DM患者的医学数据（2001-2013）。捐赠者，接受者和长期内分泌，研究了T1DM和T2DM-SPK接受者（根据ET的特殊要求分配）和同期接受KTA的T2DM患者的代谢和移植结果。结果89例T1DM和12例T2DM患者接受了SPK，26例T2DM患者接受了KTA。T1DM组的1年和5年患者生存率分别为89.9％和88.8％，T2DM组为91.7％和83.3％，T2DM KTA组为92.3％和69.2％（p <0.01）。T1DM组的SPK受体在1年和5年时的精算胰腺移植存活率为83.1％和78.7％，T2DM组为91.7和83.3％（p = 0.71）。T1DM的5年肾脏同种异体移植存活率为7.8％，T2DM的为83.3％，T2DM KTA的为65.4％（p <0.01）。接受KTA的2型糖尿病患者的延迟移植物功能（DGF）率明显更高。SPK移植和KTA后，T1DM和T2DM接受者的手术，免疫和感染并发症分别显示出相似的结果。关于脂质分布，与移植前的T2DM患者相比，T1DM接受者的平均高密度脂蛋白（HDL）-胆固醇水平显着更高（p = 0.02），并且在随访期间仍保持显着水平。结论我们的数据表明，就代谢功能而言，一组选定的T2DM患者可从SPK移植中受益。仍然有必要对T2DM患者的SPK移植适应症达成共识性指南和进一步研究。与移植前的T2DM患者相比，T1DM接受者的平均高密度脂蛋白（HDL）-胆固醇水平显着更高（p = 0.02），并且在随访期间仍保持显着水平。结论我们的数据表明，就代谢功能而言，一组选定的T2DM患者可从SPK移植中受益。仍然有必要对T2DM患者的SPK移植适应症达成共识性指南和进一步研究。与移植前的T2DM患者相比，T1DM接受者的平均高密度脂蛋白（HDL）-胆固醇水平显着更高（p = 0.02），并且在随访期间仍保持显着水平。结论我们的数据表明，就代谢功能而言，一组选定的T2DM患者可从SPK移植中受益。仍然有必要对T2DM患者的SPK移植适应症达成共识性指南和进一步研究。