title: Long-term beneficial effect of islet transplantation on diabetic macro-/microangiopathy in type 1 diabetic kidney-transplanted patients.
abstract: OBJECTIVE
  Our aim was to evaluate the long-term effects of transplanted islets on diabetic macro-/microangiopathy in type 1 diabetic kidney-transplanted patients.
  
  
  METHODS
  A total of 34 type 1 diabetic kidney-transplanted patients underwent islet transplantation and were divided into two groups: successful islet-kidney transplantation (SI-K; 21 patients, fasting C-peptide serum concentration >0.5 ng/ml for >1 year) and unsuccessful islet-kidney transplantation (UI-K; 13 patients, fasting C-peptide serum concentration <0.5 ng/ml). Patients cumulative survival, cardiovascular death rate, and atherosclerosis progression were compared in the two groups. Skin biopsies, endothelial dependent dilation (EDD), nitric oxide (NO) levels, and atherothrombotic risk factors [von Willebrand factor (vWF) and D-dimer fragment (DDF)] were studied cross-sectionally.
  
  
  RESULTS
  The SI-K group showed a significant better patient survival rate (SI-K 100, 100, and 90% vs. UI-K 84, 74, and 51% at 1, 4, and 7 years, respectively, P = 0.04), lower cardiovascular death rate (SI-K 1/21 vs. UI-K 4/13, chi(2) = 3.9, P = 0.04), and lower intima-media thickness progression than the UI-K group (SI-K group: delta1-3 years -13 +/- 30 micro m vs. UI-K group: delta1-3 years 245 +/- 20 micro m, P = 0.03) with decreased signs of endothelial injuring at skin biopsy. Furthermore, the SI-K group showed a higher EDD than the UI-K group (EDD: SI-K 7.8 +/- 4.5% vs. UI-K 0.5 +/- 2.7%, P = 0.02), higher basal NO (SI-K 42.9 +/- 6.5 vs. UI-K 20.2 +/- 6.8 micro mol/l, P = 0.02), and lower levels of vWF (SI-K 138.6 +/- 15.3 vs. UI-K 180.6 +/- 7.0%, P = 0.02) and DDF (SI-K 0.61 +/- 0.22 vs. UI-K 3.07 +/- 0.68 micro g/ml, P < 0.01). C-peptide-to-creatinine ratio correlated positively with EDD and NO and negatively with vWF and DDF.
  
  
  CONCLUSIONS
  Successful islet transplantation improves survival, cardiovascular, and endothelial function in type 1 diabetic kidney-transplanted patients.
authors.affiliation: Department of Internal Medicine I, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Fiorina
authors.forename: Franco
authors.initials: F
authors.lastname: Folli
authors.forename: Federico
authors.initials: F
authors.lastname: Bertuzzi
authors.forename: Paola
authors.initials: P
authors.lastname: Maffi
authors.forename: Giovanna
authors.initials: G
authors.lastname: Finzi
authors.forename: Massimo
authors.initials: M
authors.lastname: Venturini
authors.forename: Carlo
authors.initials: C
authors.lastname: Socci
authors.forename: Alberto
authors.initials: A
authors.lastname: Davalli
authors.forename: Elena
authors.initials: E
authors.lastname: Orsenigo
authors.forename: Lucilla
authors.initials: L
authors.lastname: Monti
authors.forename: Luca
authors.initials: L
authors.lastname: Falqui
authors.forename: Silvia
authors.initials: S
authors.lastname: Uccella
authors.forename: Stefano
authors.initials: S
authors.lastname: La Rosa
authors.forename: Luciana
authors.initials: L
authors.lastname: Usellini
authors.forename: Giuliana
authors.initials: G
authors.lastname: Properzi
authors.forename: Valerio
authors.initials: V
authors.lastname: Di Carlo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Del Maschio
authors.forename: Carlo
authors.initials: C
authors.lastname: Capella
authors.forename: Antonio
authors.initials: A
authors.lastname: Secchi
mesh_terms: D000328:Adult; D002096:C-Peptide / Q000097:blood; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D003925:Diabetic Angiopathies / Q000628:therapy*; D003928:Diabetic Nephropathies / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016381:Islets of Langerhans Transplantation / Q000401:mortality / Q000473:pathology / Q000502:physiology*; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery; D016030:Kidney Transplantation / Q000401:mortality / Q000473:pathology / Q000502:physiology*; D008297:Male; D015996:Survival Rate; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D002096:C-Peptide