. – : . . , 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