Cardiovascular outcomes after kidney-pancreas and kidney-alone transplantation.
BACKGROUND
This study retrospectively assessed, with an intention-to-treat analysis, the effect of kidney-pancreas transplantation (KP) on survival and cardiovascular outcome in type 1 diabetic uremic patients.


METHODS
A total of 351 uremic type 1 diabetic patients were enrolled on a waiting list for KP: 130 underwent KP transplantation, 25 underwent kidney transplantation alone (KA), whereas 196 patients remained on dialysis (WL). The three populations had similar cardiovascular conditions. Actuarial survival rates and causes of death were recorded over a period of seven years. Finally, 23 KP and 13 KA patients underwent left radionuclide ventriculography, during a follow-up of four years.


RESULTS
In the entire group of 351 patients the seven-year survival rate was 77.4% for KP, 56.0% for KA and 39.6% for WL (KP vs. WL, P = 0.01). Cardiovascular death rate was 7.6% in KP, 20.0% in KA and 16.1% in WL (KP versus WL, P = 0.03; KP vs. KA, P = 0.16). In the subsample studied with radionuclide ventriculography, left ventricular ejection fraction improved in KP, but did not in KA, with significant differences between groups at two and four years. At four years only the KP patients presented normal values of diastolic parameters, including the peak filling rate, time-to-peak filling rate, and peak filling rate/peak ejection rate ratio. Glycated hemoglobin was negatively associated with the ejection fraction, peak filling rate and peak filling rate/peak ejection rate ratio, and positively associated with the time-to-peak filling rate.


CONCLUSIONS
Normalization of blood glucose metabolism and improvement of blood pressure control obtained with KP transplant is associated with positive effects on survival, cardiovascular death rate, and left ventricular function.
La Rocca
E
E
Department of Internal Medicine, San Raffaele Scientific Institute, Universitá Vita e Salute, Via Olgettina 60, 20132 Milan, Italy.
Fiorina
P
P
di Carlo
V
V
Astorri
E
E
Rossetti
C
C
Lucignani
G
G
Fazio
F
F
Giudici
D
D
Cristallo
M
M
Bianchi
G
G
Pozza
G
G
Secchi
A
A
D000328:Adult; D002423:Cause of Death; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D016277:Ventricular Function, Left