title: Impact of simultaneous pancreas and kidney transplantation on progression of coronary atherosclerosis in patients with end-stage renal failure due to type 1 diabetes.
abstract: OBJECTIVE
  Mortality in type 1 diabetic patients with end-stage renal failure is high and dominated by coronary atherosclerotic events. With regard to prognosis, simultaneous transplantation of pancreas and kidney (SPK) may be superior to kidney transplantation alone (KTA) in type 1 diabetic patients, because normalization of blood glucose levels may reduce progression of coronary atherosclerosis and because it is well known that progression of coronary atherosclerosis is one of the major factors that determines clinical prognosis. However, no data are available on progression of coronary atherosclerosis after SPK.
  
  
  METHODS
  We performed an observational angiographic study comparing progression of coronary atherosclerosis, analyzed with quantitative coronary angiography, in patients with (n = 26) and those without (n = 6) a functioning pancreas graft after SPK, to test the hypothesis that normalization of blood glucose levels by SPK may indeed reduce progression of coronary atherosclerosis in type 1 diabetic patients and thereby improve prognosis.
  
  
  RESULTS
  Mean follow-up was 3.9 years. Average glucose control was significantly worse for the patients without a pancreas graft than for patients with a functioning pancreas graft: 11.3 (SD 3.5) vs. 5.9 mmol/l (SD 1.1) (P = 0.03). Mean segment diameter loss (progression of diffuse coronary atherosclerosis) was 0.024 mm/year (SD 0.067) in patients with a functioning pancreas graft, compared with 0.044 mm/year (SD 0.038) in patients in whom the pancreas graft was lost. Minimum obstruction diameter loss (progression of focal coronary atherosclerosis) was 0.037 mm/year (SD 0.086) in patients with a functioning pancreas graft compared with 0.061 mm/year (SD 0.038) in patients in whom the pancreas graft was lost. Regression of atherosclerosis occurred in 38% of patients with a functioning pancreas graft compared with 0% of patients of whom the pancreas graft was lost (P = 0.035).
  
  
  CONCLUSIONS
  Our study provides, for the first time, evidence that in patients who have undergone SPK, progression of coronary atherosclerosis in patients with a functioning pancreas graft is reduced compared with patients with pancreas graft failure. Our observation is an important part of the explanation for the observed improved mortality rates reported in type 1 diabetic patients with end-stage renal failure after SPK compared with KTA. In light of these findings described above, SPK must to be carefully considered for all diabetic transplant candidates.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. j.w.jukema@lumc.nl
authors.forename: J Wouter
authors.initials: JW
authors.lastname: Jukema
authors.forename: Yves F C
authors.initials: YF
authors.lastname: Smets
authors.forename: Johan W
authors.initials: JW
authors.lastname: van der Pijl
authors.forename: Aeilko H
authors.initials: AH
authors.lastname: Zwinderman
authors.forename: Hubert W
authors.initials: HW
authors.lastname: Vliegen
authors.forename: Jan
authors.initials: J
authors.lastname: Ringers
authors.forename: Johan H C
authors.initials: JH
authors.lastname: Reiber
authors.forename: Herman H P J
authors.initials: HH
authors.lastname: Lemkes
authors.forename: Ernst E
authors.initials: EE
authors.lastname: van der Wall
authors.forename: Johan W
authors.initials: JW
authors.lastname: de Fijter
mesh_terms: D000328:Adult; D001786:Blood Glucose; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000503:physiopathology*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000601:surgery; D018450:Disease Progression; D005260:Female; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D016035:Pancreas Transplantation; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose