title: Patient survival and cardiovascular events after kidney-pancreas transplantation: comparison with kidney transplantation alone in uremic IDDM patients.
abstract: In diabetic patients cardiovascular morbidity and mortality is still a major problem. Our aim was to study the effect of kidney-pancreas transplantation on survival, cardiovascular events, and causes of death in diabetic type 1 uremic patients. Three hundred and thirty-three uremic IDDM patients were enrolled in our waiting list for kidney-pancreas transplantation: 107 underwent kidney-pancreas transplantation (KP), 34 underwent kidney transplantation alone (KA), whereas 192 patients remained on dialysis (WL). Actuarial survival and causes of death were recorded over a period of 7 years. Seven-year survival rate was 75% for the KP group, 63% for the KA group, and 37% for the WL group (p = 0.001). Cardiovascular death rate was 9.8% in the KP group, 17.6% in the KA group, and 18.1% in the WL group (KP vs. WL, p = 0.05). Rate of acute myocardial infarction in the KP group was lower than in the KA group (2.4% vs. 17.6%, p = 0.005) as well as rate of acute pulmonary edema (0.8% vs. 23.5%, p = 0.0001) and rate of hypertensive patients at 1 (40.9% vs. 85.0%, p = 0.0001) and at 2 years (57.6% vs. 80%, p = 0.03). Kidney-pancreas transplant helped to obtain euglycemia with positive effects on survival and cardiovascular events.
authors.affiliation: Department of Internal Medicine, San Raffaele Scientific Institute, Milano, Italy.
authors.forename: E
authors.initials: E
authors.lastname: La Rocca
authors.forename: P
authors.initials: P
authors.lastname: Fiorina
authors.forename: E
authors.initials: E
authors.lastname: Astorri
authors.forename: C
authors.initials: C
authors.lastname: Rossetti
authors.forename: G
authors.initials: G
authors.lastname: Lucignani
authors.forename: F
authors.initials: F
authors.lastname: Fazio
authors.forename: D
authors.initials: D
authors.lastname: Giudici
authors.forename: R
authors.initials: R
authors.lastname: Castoldi
authors.forename: G
authors.initials: G
authors.lastname: Bianchi
authors.forename: V
authors.initials: V
authors.lastname: Di Carlo
authors.forename: G
authors.initials: G
authors.lastname: Pozza
authors.forename: A
authors.initials: A
authors.lastname: Secchi
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000401:mortality; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality / Q000601:surgery*; D003925:Diabetic Angiopathies / Q000401:mortality; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000401:mortality*; D016019:Survival Analysis; D014511:Uremia / Q000401:mortality / Q000601:surgery*