Emostasi nei pazienti diabetici e uremici: Impatto del trapianto di rene e pancreas

Background and aims. To evaluate the effects of kidney or kidney-pancreas transplantation on platelet and haemostatic abnormalities in uremic type 1 diabetic patients, we conducted a cross-sectional study involving 12 type 1 diabetic patients (T1DM), 30 uremic type 1 diabetic patients (U-T1DM), 27 uremic type 1 diabetic kidney-pancreas transplanted patients (KP), 12 uremic type 1 diabetic kidney-alone transplanted patients (KD), 13 healthy controls (C). Method and result. We evaluated platelet and function, including intracellular calcium level, and clotting system. Resting calcium level were significantly higher in U-T1DM and KD group than KP/C groups (U-T1DM = 137.6 ± 11.2, KD = 133.3 ± 16.6, T1DM = 60.9 ± 7.7, KP = 97.2 ± 9.2, C = 72.0 ± 11.0 nM, p < 0.01). CD41 expression was significantly reduced in platelet from U-T1DM group compared to the other groups (U-T1DM = 53.2 ± 7.7%, KP = 75.7 ± 6.2%, KD = 80.4 ± 4.3%, C = 81.6 ± 2.2%, T1DM = 82.6 ± 3.4%, p < 0.05). Diabetic patients showed higher levels of thrombin platelet expression than non diabetic patients. Levels of hypercoagulability markers in the KP group, and to a lesser extent KD group but not the U-T1DM group, were similar to those of the C group. A reduction in the natural anticoagulants was evident in U-T1DM group, while near-normal values were observed in KP and KD groups. Conclusions. Haemostatic abnormalities were not observed in KP patients, but were present in KD patients and in U-T1DM patients. This could contribute to the lower cardiovascular mortality observed in KP patient compared to KD and U-T1DM patients.