title: Reversal of left ventricular diastolic dysfunction after kidney-pancreas transplantation in type 1 diabetic uremic patients.
abstract: OBJECTIVE
  Diastolic function is frequently impaired in diabetic patients. Our aim was to evaluate the effects of glycometabolic control achieved by pancreas transplantation on left ventricular function in uremic type 1 diabetic patients.
  
  
  METHODS
  Left ventricular systolic and diastolic functions were evaluated using radionuclide ventriculography in 42 kidney-pancreas transplant patients and 26 kidney-alone recipients who had similar clinical characteristics before transplantation. Patients were grouped according to 6, 24, and 48 months of follow-up. Control subjects consisted of 20 type 1 diabetic patients.
  
  
  RESULTS
  The left ventricular ejection fraction was normal in all of the patients. However, kidney-pancreas transplant patients with 4 years of graft function had a higher ejection fraction (75.7 +/- 1.8%) than kidney-alone patients with 4 years of graft function (65.3 +/- 2.8%, P = 0.02) and type 1 diabetic patients (61.3 +/- 3.7%, P = 0.004). In patients with 4 years of graft function, normal diastolic parameters were evident in kidney-pancreas but not in kidney-alone or in type 1 diabetic patients (peak filling rate: 4.46 +/- 0.15 end diastolic volume (EDV)/s in kidney-pancreas patients vs. 2.73 +/- 0.24 EDV/s [P < 0.01] and 3.39 +/- 0.30 EDV/s [P < 0.01] in kidney-alone and type 1 diabetic patients, respectively; time-to-peak filling rate: 141.9 +/- 7.8 ms in kidney-alone patients vs. 209.4 +/- 13.5 ms in kidney-alone patients [P < 0.01]; peak filling rate/peak ejection rate ratio: 1.10 +/- 0.04 in kidney-pancreas patients vs. 0.81 +/- 0.08 in kidney-alone patients [P < 0.01]). A significant reduction in diastolic dysfunction rate was observed only in kidney-pancreas patients.
  
  
  CONCLUSIONS
  Kidney-pancreas transplantation results in complete insulin independence, a better glycometabolic pattern and blood pressure control, an improvement of left ventricular function, and a reversal of diastolic dysfunction.
authors: Department of Internal Medicine, San Raffaele Scientific Institute, Milan, Italy.
authors: P
authors: P
authors: Fiorina
authors: E
authors: E
authors: La Rocca
authors: E
authors: E
authors: Astorri
authors: G
authors: G
authors: Lucignani
authors: C
authors: C
authors: Rossetti
authors: F
authors: F
authors: Fazio
authors: D
authors: D
authors: Giudici
authors: V
authors: V
authors: di Carlo
authors: M
authors: M
authors: Cristallo
authors: G
authors: G
authors: Pozza
authors: A
authors: A
authors: Secchi
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000601:surgery*; D003971:Diastole; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000628:therapy; D007328:Insulin / Q000097:blood; D016030:Kidney Transplantation; D008875:Middle Aged; D016035:Pancreas Transplantation; D011877:Radionuclide Imaging; D014280:Triglycerides / Q000097:blood; D014511:Uremia / Q000601:surgery; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*
chemical_list: D006442:Glycated Hemoglobin; D007328:Insulin; D014280:Triglycerides