血液透析を施行していた多発性嚢胞腎脳死患者をドナーとしたI型糖尿病症例における再膵移植の1例  [in Japanese] A Cadaveric Case of Pancreas Re-transplantation for IDDM Patient from a Polycystic Kidney Donor with Hemodialysis  [in Japanese]

症例は38歳の男性で14歳時よりインスリン依存型糖尿病を発症しインスリン治療を受けていた.30歳時に慢性腎不全が悪化し血液透析が導入され,34歳時には膵臓移植地域適応検討委員会の移植適応認定を受け,日本臓器移植ネットワークに登録された. 2001年1月8日脳死ドナーからの臓器提供を受け脳死下膵腎同時移植が施行された.しかし,グラフト膵の門脈血栓症を併発し術後7日目にグラフト膵の摘出を余儀なくされた.同年11月8日,膵単独移植を希望しネットワークに再登録された. 2003年10月19日,脳死ドナーの出現を受け,膵臓再移植を施行した.術後経過は良好で,術後33日には軽快退院できた.本症例は臓器移植法施行後,脳死下腎臓再移植を施行した本邦第1例目で,また多発性嚢胞腎にて血液透折中の患者で,かつ腎移植登録待機中,脳死ドナーとなり膵臓を提供した貴重な症例である.

A 38-year-old man with a history of insulin-dependent diabetes mellitus (IDDM) since age 14, underwent cadaveric simultaneous pancreas-kidney transplantation at age 35, but required transplant pancreatectomy on day 7 after the transplantation, due to portal vein thrombosis. Renal allograft function was, however, well preserved. He subsequently recovered with good renal function. Two years and 10 months later, pancreas retransplantation from a polycystic kidney donor with hemodialysis was conducted. Initial evaluation by abdominal ultrasound showed multiple cysts in the kidneys and liver, but no cystic change was detected in the pancreas. Ultimately, we decided to use the pancreas for transplantation. This is, to our knowledge, the first cadaveric case of pancreas retransplantation in Japan since the brain death law went into effect in 1997. The patient had uneventful clinical course through out hospitalization and suffered no surgical complications, such as.rejection or infection. He was discharged on postgrafting 33 day without insulin support and restarted his regular work 3 month after transplantation. Polycystic kidney disease is a systemic disorder with slow progressive deterioration of different organ functions. Typically, the kidneys begin to develop cystic enlargement in adulthood. Given the shortage of cadaveric donors in Japan, polycystic kidney donors with normal organ function are potential candidate organ donors provided that organs are carefully evaluated before donation.