Сочетанная трансплантация почки и поджелудочной железы

.
–
:
.
.
, 2012
»
•
, 1995: «
•
, 2006: «
»
• IDF , 2010
:
5%
•
(9 – 10
450
400
350
300
250
200
150
100
50
0
.; 438
.; 285
.; 151
2000 .
2010 .
2030 .
)
1
I
19 – 26%,
,
:
10 - 15
2-
25 - 30
)
15%
:
: 41% vs 64%;
: 36% vs 76%
«…
…»
)
Richard Lillehei, University of Wisconsin, 1966
:
( 10%)
:
2
–
Simultaneous
Pancreas and
Kidney transplantation
:
•
:
Simultaneous Pancreas and Kidney transplantation – SPK
•
:
Pancreas After Kidney transplantation -
•
PAK
:
Pancreas Transplantation Alone - PTA
3
4
.
:
– 53 (20.9%)
I
– 38 (15%),
:
SPK – 34 (89.5%)
– 4 (10.5%)
II
– 15 (5.9%)
5
- 1:17
2500
2000
1500
Donor
Pancreas
1000
500
0
2001
2002
2003
2004
2005
Eurotransplant 2001-2005
45
(
)
6
1978 . J. Dubernard
1966 . R. Lillehei
1973 . – G. Gliedman
1983 . - H. Sollinger
1987 . - D.D.Nghiem & R.J.Corry
7
n=7
n=8+4
12-
8
n=4
2
9
10
SRTR:
80%
(2003 - 2007 .)
KP-Tx
60%
40%
20%
0%
Tac+MMF
CyA+MMF
Tac+Siro
CyA+Siro
SRTR:
90%
-2
80%
70%
60%
50%
40%
30%
20%
10%
0%
Tac+MMF
CyA+MMF
Tac+Siro
CyA+Siro
11
:
:
•
•
10
- 0 – 14
: C0 TAC 8 – 12
- 14 – 28
: C0 TAC 6 – 10
28
: C0 TAC 5 – 8
–
2
!!!)
1,44
2
)
20
•
10
28- ,
19
5
60-
)
I
•
– 10,
– 9;
– 35,3 . (26 – 43 .)
•
: 9 – 17
•
: 20
•
: 30 – 85
•
: 1.2 – 10
•
:
– 12,
– 7.
•
– 10;
– 5.
•
– 11;
– 3.
• HLA missmatch: 4.3 (2 – 6)
•
:
– 5.5 (1.5 – 13);
– 9.2 (5.5 – 16)
•
:
– 16;
– 3.
12
:
:
•
– 19
HbA1c – 5.4%
– 12.3
– 5.9
– 184
– 153
– 132
– 2 (1.5 2
,
.,
.
–1
)
1
)
:
13
:
:
•
– 16 (84.2%)
– 3 (15.8%)
(2B Banff’97) – 1 (5.3%)
– 1 (5.3%)
– 101
– 5.6
:
:
•
– 18 (94.7%)
– 18 (94.7%)
– 17 (89,5%)
•
:
– 1 (94.7%)
– 1 (94.7%)
,
,
,
,4
)
)
– 2 (10.5%)
14
:
•
.
•
.
•
.
,
,
•
.
.
•
.
15