Background. The aim of this study was to evaluate the effects of islet transplantation on patient survival and diabetic vascular complications. Methods. Thirty-seven type 1 uremic diabetic kidney transplant patients underwent islet transplantation (KI group). Uremic type 1 diabetic kidney-pancreas (KP group, n=162), kidney-alone (KD group, n=42) transplant patients, and uremic type 1 diabetic patients still on hemodialysis (HD+DM group, n=196) constituted the control groups for survival and endothelial morphology. Results. Patient survival was similar in the KI and KP groups and higher than in the HD+DM group (P<0.05). Patients experiencing long-term islet function (KI-successful [KI-s], n=24) showed a better survival (100%, 100%, and 90%) than those in the KI group who lost islet function (KI-unsuccessful [KI-u], n=13) (84%, 75%, and 45%) at 1, 4 and 7 years, respectively (P=0.02). The cardiovascular death rate for the KI group (18%) was similar to the KD group (19%) but lower when the KI-s group is considered alone (5%), and showed a cardiovascular death rate similar to the KP group (8%). The KI-s group showed a good metabolic profile, with reduction of exogenous insulin requirement and persistent C-peptide secretion, as compared with the KI-u group. The endothelial morphology was evaluated with a skin biopsy obtained in all groups. The KI-s and the KP groups demonstrated decreased signs of endothelial injury compared with the KI-u and HD+DM groups. The KI group showed a better atherothrombotic profile than the HD+DM group, with higher levels of natural anticoagulant protein. Conclusions. Successful islet transplantation improves survival, atherothrombotic profile, and endothelial morphology in uremic type 1 diabetic kidney transplant patients.
Islet transplantation improves vascular diabetic complications in patients with diabetes who underwent kidney transplantation: A comparison between kidney-pancreas and kidney-alone transplantation / P. Fiorina, F. Folli, P. Maffi, C. Placidi, M. Venturini, G. Finzi, F. Bertuzzi, A. Davalli, A. D'Angelo, C. Socci, C. Gremizzi, E. Orsenigo, S. La Rosa, M. Ponzoni, M. Cardillo, M. Scalamogna, A. Del Maschio, C. Capella, V. Di Carlo, A. Secchi. - In: TRANSPLANTATION. - ISSN 0041-1337. - 75:8(2003), pp. 1296-1301.
|Titolo:||Islet transplantation improves vascular diabetic complications in patients with diabetes who underwent kidney transplantation: A comparison between kidney-pancreas and kidney-alone transplantation|
FOLLI, FRANCO (Secondo)
DI CARLO, VALERIO (Penultimo)
SECCHI, ANTONIO (Ultimo)
|Parole Chiave:||Transplantation; Immunology|
|Settore Scientifico Disciplinare:||Settore MED/09 - Medicina Interna|
|Data di pubblicazione:||2003|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1097/01.TP.0000061788.32639.D9|
|Appare nelle tipologie:||01 - Articolo su periodico|