The Clinical Research Of Issue Of Pancreas And Duodenum And Renal Transpl Antation Treatment Diabetic End-stage Renal Disease

Objective To analyze and study diabete nephropathys patients who undergo pancreas, duodenum and kidney combined transplantation postoperative periope rative complications and therapeutic strategies,and to explore and summarize the evaluation and maintenance of the function of donor organs,the improved way of obtain organs, the key technology of perioperative treatment and simultaneous pancreas kidney transplants.Methods Clinical data of 10 cases undergoing simultaneous pancreas-kidney transplantation in Department of transplantation.the 303 Hospital of Chinese PLA Genera I Hospital between 2010 and 2014 were retrospectively analyzed to summarize the application of perioperative clinical monitoring focus and the innovation of the key technologies.Results All of 10 transplant cases were performed successfully,all the patients with postoperative daily urine output at 3500 ~ 5500 ml, creatinine have fallen to below 150 u mol/L and BUN dropped to under tendency for 7.1mmol/L,the urine amylase maintain of the BD cases in 3000 ~ 10000 u/L. All patientsbecome insulin-independent after he had been treated by small dose insulin for 2~3 days, fasting plasma glucose back to 4.5 ~ 7.1mmol/L.AR happened in 1 patient after surgery, and recovered by high dose methylprednisolone.,CNI drug poisoning happened in 1 patient after surgery, but kidney function recovered by reducing drug dose.1 patients had urinary tract infection after surgery respectively,1 patients had hematuria, which disappeared, all of them recovered by treatment. 1 patients had pulmonary infection after surgery, he recovered after treatment. 10 patients were recovered and discharged, the average hospitalization time about 23 days.Conclusion StageⅠpancreas, duodenum and kidney combined transplantation is an effective therapy of ESRD. Donated graft protection system foundation can insure DBD/DCD donated organs be applied to multi-organ combined transplantation. According to the CYP3A5 genetic polymorphism, immunosuppressive regimen after pancreas and kidney combined transplantation can be made, and this can reduce post transplantation acute rejection and drug adverse reaction.Anticoagulation stratery, which based on thromboelastogram, can prevent bleeding and thrombus effectively.