Patient survival and cardiovascular events after kidney-pancreas transplantation: comparison with kidney transplantation alone in uremic IDDM patients.
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.
La Rocca
E
E
Department of Internal Medicine, San Raffaele Scientific Institute, Milano, Italy.
Fiorina
P
P
Astorri
E
E
Rossetti
C
C
Lucignani
G
G
Fazio
F
F
Giudici
D
D
Castoldi
R
R
Bianchi
G
G
Di Carlo
V
V
Pozza
G
G
Secchi
A
A
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*