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中华移植杂志(电子版) ›› 2026, Vol. 20 ›› Issue (02) : 73 -81. doi: 10.3877/cma.j.issn.1674-3903.2026.02.001

专家共识

移植胰腺切除专家共识(2026版)
中华医学会器官移植学分会   
  1. 1. 广州医科大学附属第二医院,511447 广州
    2. 西安交通大学第一附属医院,710061 西安
  • 收稿日期:2026-01-29 出版日期:2026-04-25
  • 基金资助:
    广州地区临床高新和重大技术项目(2023GX041)

Expert consensus on pancreatic allograft resection (2026 edition)

Branch of Organ Transplantation of Chinese Medical Association   

  1. 1. the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 511447, China
    2. the First Affiliated Hospital of Xi′an Jiaotong University, Xi′an 710061, China
  • Received:2026-01-29 Published:2026-04-25
引用本文:

中华医学会器官移植学分会. 移植胰腺切除专家共识(2026版)[J/OL]. 中华移植杂志(电子版), 2026, 20(02): 73-81.

Branch of Organ Transplantation of Chinese Medical Association. Expert consensus on pancreatic allograft resection (2026 edition)[J/OL]. Chinese Journal of Transplantation(Electronic Edition), 2026, 20(02): 73-81.

移植胰腺切除术是处理移植胰腺失功后严重并发症的关键外科手段,直接关系受者预后,目前国内外尚缺乏相关专家共识或指南以规范其临床应用。本共识系统阐述移植胰腺切除术的适应证划分、手术时机选择、术式操作要点、围手术期管理及心理评估与干预策略。适应证按发生时间分为早期(如血栓形成、移植胰腺炎)、中期(如腹腔感染、侵袭性血管炎)和晚期(如排斥反应、血管并发症和新发肿瘤)适应证,并明确建议对无症状失功移植物采取保守治疗策略;手术方式需依据原移植术式(包括体静脉/门静脉回流及肠道/膀胱引流方式)进行个体化操作,其核心包括血管控制、血栓处理及消化道/泌尿系统吻合口重建;术后管理涵盖并发症的处理、血糖调控、免疫抑制方案调整与系统性心理社会干预,强调多学科协作以全面优化患者预后。本共识旨在为临床实践提供标准化参照,最终提升受者长期生存质量。

Pancreatic allograft resection serves as a critical surgical intervention for severe complications arising from pancreatic allograft dysfunction, directly influencing recipient outcomes. Currently, no expert consensus or guidelines are available domestically and internationally to standardize its clinical application. This consensus systematically delineates the indications, timing, key technical aspects, perioperative management, and psychological assessment and intervention strategies for pancreatic allograft resection. Indications are classified by time of onset into early (thrombosis, transplant pancreatitis), intermediate (intra-abdominal infection, invasive vasculitis), and late stage (rejection, vascular complications, and de novo tumor), with a clear recommendation for conservative management in asymptomatic allograft dysfunction. Surgical techniques should be tailored to the original transplant procedure (including systemic/portal venous drainage and enteric/bladder drainage methods), focusing on vascular control, thrombosis management, and reconstruction of digestive/urinary anastomoses. Postoperative management involves management of complications, blood glucose regulation, adjustment of immunosuppressive regimens, and systematic psychosocial interventions, underscored by multidisciplinary collaboration to optimize patient outcomes. This consensus aims to establish a standardized reference for clinical practice, ultimately improving long-term quality of life for recipients.

1
Doherty DT, Tan J, Mcfarlane R, et al. Jejunal or ileal exocrine drainage in pancreas transplantation: impact on gastrointestinal function[J]. Exp Clin Transplant, 202321(7):586-591.
2
Parajuli S, Odorico J, Astor BC, et al. Incidence and indications for late allograft pancreatectomy while on continued immunosuppression[J]. Transplantation, 2017, 101(9): 2228-2234.
3
Farney AC, Rogers J, Stratta RJ. Pancreas graft thrombosis: causes, prevention, diagnosis, and intervention[J]. Curr Opin Organ Transplant, 201217(1):87-92.
4
Drachenberg CB, Papadimitriou JC, Farney A, et al. Pancreas transplantation: the histologic morphology of graft loss and clinical correlations[J]. Transplantation, 200171(12):1784-1791.
5
Gruessner RWG, Gruessner AC. Transplantation of the pancreas[M]. 2nd ed. New York: Springer, 2023.
6
Gruessner AC, Gruessner RWG. Pancreas transplantation for patients with type 1 and type 2 diabetes mellitus in the United States: a registry report[J]. Gastroenterol Clin North Am, 201847(2):417-441.
7
Harbell JW, Morgan T, Feldstein VA, et al. Splenic vein thrombosis following pancreas transplantation: identification of factors that support conservative management[J]. Am J Transplant, 201717(11):2955-2962.
8
Kopp WH, van Leeuwen CAT, Lam HD, et al. Retrospective study on detection, treatment, and clinical outcome of graft thrombosis following pancreas transplantation[J]. Transpl Int, 201932(4):410-417.
9
Wallace DF, Bunnett J, Fryer E, et al. Early allograft pancreatectomy-technical failure or acute pancreatic rejection?[J]. Clin Transplant, 201933(10):e13702.
10
Kandaswamy R, Stock PG, Miller JM, et al. OPTN/SRTR 2022 annual data report: pancreas[J]. Am J Transplant, 202424(2S1): S119-S175.
11
Finger EB, Radosevich DM, Dunn TB, et al. A composite risk model for predicting technical failure in pancreas transplantation[J]. Am J Transplant, 201313(7):1840-1849.
12
Rudolph EN, Dunn TB, Sutherland DER, et al. Optimizing outcomes in pancreas transplantation: impact of organ preservation time[J]. Clin Transplant, 201731(9): e13035.
13
Hakeem A, Chen J, Iype S, et al. Pancreatic allograft thrombosis: suggestion for a CT grading system and management algorithm[J]. Am J Transplant, 201818(1):163-179.
14
Kim YH, Park JB, Lee SS, et al. How to avoid graft thrombosis requiring graftectomy: immediate posttransplant CT angiography in pancreas transplantation[J]. Transplantation, 201294(9):925-930.
15
Fridell JA, Mangus RS, Mull AB, et al. Early reexploration for suspected thrombosis after pancreas transplantation[J]. Transplantation, 201191(8):902-907.
16
Nagai S, Powelson JA, Taber TE, et al. Allograft pancreatectomy: indications and outcomes[J]. Am J Transplant, 201515(9):2456-2464.
17
Muthusamy ASR, Giangrande PLF, Friend PJ. Pancreas allograft thrombosis[J]. Transplantation, 201090(7):705-707.
18
Laurence JM, Cattral MS. Techniques of pancreas graft salvage/indications for allograft pancreatectomy[J]. Curr Opin Organ Transplant, 201621(4):405-411.
19
Barrufet M, Burrel M, Angeles Garcia-Criado M, et al. Pancreas transplants venous graft thrombosis: endovascular thrombolysis for graft rescue[J]. Cardiovasc Intervent Radiol, 201437(5):1226-1234.
20
Han K, Ko HK, Tsauo J, et al. Endovascular management for the treatment of pancreas transplant venous thrombosis: a single-center experience[J]. J Vasc Interv Radiol, 201627(6):882-888.
21
Shahbazov R, Azari F, Whan PA, et al. The successful salvage of a thrombosed pancreatic graft at the early postoperative period of a simultaneous pancreas and kidney transplantation[J]. Int J Surg Case Rep, 201845:116-120.
22
尹威,李萌,方佳丽,等. 改良供胰尾端脾动静脉分流术在胰肾联合移植中的临床疗效分析[J]. 中华器官移植杂志202546(3):219-225.
23
Gunasekaran G, Wee A, Rabets J, et al. Duodenoduodenostomy in pancreas transplantation[J]. Clin Transplant, 201226(4):550-557.
24
Troppmann C. Complications after pancreas transplantation[J]. Curr Opin Organ Transplant, 201015(1):112-118.
25
Flateau C, Ait-Ammar N, Angebault C, et al. Risk factors for intra-abdominal fungal infection after simultaneous pancreas-kidney transplantation: a single-center retrospective experience[J]. Transpl Infect Dis, 202123(2):e13486.
26
Fridell JA, Rogers J, Stratta RJ. The pancreas allograft donor: current status, controversies, and challenges for the future[J]. Clin Transplant, 201024(4):433-449.
27
Liong SY, Dixon RE, Chalmers N, et al. Complications following pancreatic transplantations: imaging features[J]. Abdom Imaging, 201136(2):206-214.
28
Ferrer-Fabrega J, Cano-Vargas B, Ventura-Aguiar P, et al. Early intestinal complications following pancreas transplantation: lessons learned from over 300 cases - a retrospective single-center study[J]. Transpl Int, 202134(1):139-152.
29
Ray S, Hobeika C, Norgate A, et al. Evolving trends in the management of duodenal leaks after pancreas transplantation: a single-centre experience[J]. Transpl Int, 202437:13302.
30
Pappas PG, Alexander BD, Andes DR, et al. Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET)[J]. Clin Infect Dis, 201050(8):1101-1111.
31
Aslam S, Rotstein C. Candida infections in solid organ transplantation: guidelines from the american society of transplantation infectious diseases community of practice[J]. Clin Transplant, 201933(9): e13623.
32
Filmer RB, Spencer JR. Malignancies in bladder augmentations and intestinal conduits[J]. J Urol, 1990143(4):671-678.
33
Dillman JR, Elsayes KM, Bude RO, et al. Imaging of pancreas transplants: postoperative findings with clinical correlation[J]. J Comput Assist Tomogr, 200933(4):609-617.
34
O′Malley RB, Moshiri M, Osman S, et al. Imaging of pancreas transplantation and its complications[J]. Radiol Clin North Am, 201654(2):251-266.
35
Hameed M, Hameed S, Harvey C, et al. Imaging in whole organ pancreatic transplants and a multimodality review of its complications[J]. Br J Radiol, 202194(1122):20200106.
36
Swensson J, Nagaraju S, O′Brien D, et al. Contrast-enhanced ultrasound of the transplant pancreas in the post-operative setting[J]. Clin Transplant, 201933(12):e13733.
37
Ramalho M, Ramalho J, Burke LM, et al. Gadolinium retention and toxicity-an update[J]. Adv Chronic Kidney Dis, 201724(3):138-146.
38
Gruessner RWG, Sutherland DER, Drangstveit MB, et al. Pancreas allotransplants in patients with a previous total pancreatectomy for chronic pancreatitis[J]. J Am Coll Surg, 2008206(3):458-465.
39
Maiti A, Das A, Smith DT. Phlegmasia cerulea dolens[J]. Postgrad Med J, 201692(1093):690.
40
Perosa M, Noujaim H, Ianhez LE, et al. Experience with 53 portal-duodenal drained solitary pancreas transplants[J]. Clin Transplant, 201428(2):198-204.
41
Stratta RJ. Experience with allograft pancreatectomy after pancreas transplantation[J]. Transplant Proc, 199830(2):443.
42
Meloche RM. Transplantation for the treatment of type 1 diabetes[J]. World J Gastroenterol, 200713(47):6347-6355.
43
Foldes K, Piros L, Toronyi E, et al. Examination of carbohydrate metabolism parameters after simultaneous pancreas-kidney transplantation[J]. Transplant Proc, 201345(10):3698-3702.
44
Moiz A, Filion KB, Tsoukas MA, et al. The expanding role of GLP-1 receptor agonists: a narrative review of current evidence and future directions[J]. EClinicalMedicine, 202586:103363.
45
Patel A, Macmahon S, Chalmers J, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes[J]. N Engl J Med, 2008358(24):2560-2572.
46
Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diabetes[J]. N Engl J Med, 2009360(2):129-139.
47
中华医学会糖尿病学分会. 中国糖尿病防治指南(2024版)[J]. 中华糖尿病杂志202517(1):16-139.
48
Gaede P, Lund-Andersen H, Parving HH, et al. Effect of a multifactorial intervention on mortality in type 2 diabetes[J]. N Engl J Med, 2008358(6):580-591.
49
Al-Naseem AO, Attia A, Gonnah AR, et al. Pancreas transplantation today: quo vadis?[J]. Eur J Endocrinol, 2023188(4):R73-R87.
50
中华医学会器官移植学分会. 器官移植免疫抑制剂临床应用技术规范(2019版)[J]. 器官移植201910(3):213-226.
51
Isla Pera P, Moncho Vasallo J, Guasch Andreu O, et al. Impact of simultaneous pancreas-kidney transplantation: patients′ perspectives[J]. Patient Prefer Adherence, 20126:597-603.
52
Pérez-San-Gregorio MA, Martín-Rodríguez A, Díaz-Domínguez R, et al. The influence of posttransplant anxiety on the long-term health of patients[J]. Transplant Proc, 200638(8):2406-2408.
53
Dew MA, Rosenberger EM, Myaskovsky L, et al. Depression and anxiety as risk factors for morbidity and mortality after organ transplantation: a systematic review and meta-analysis[J]. Transplantation, 2015100(5):988-1003.
54
Cordoza M, Koons B, Perlis ML, et al. Self-reported poor quality of sleep in solid organ transplant: a systematic review[J]. Transplant Rev (Orlando), 202135(4):100650.
55
Jackson S, Simonds LM, Smith RM. Pancreas and islet transplantation: psychological themes pre- and posttransplant[J]. Curr Opin Organ Transplant, 201520(2):211-215.
56
Jowsey SG, Taylor ML, Schneekloth TD, et al. Psychosocial challenges in transplantation[J]. J Psychiatr Pract, 20017(6):404-414.
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