Islet transplantation improves vascular diabetic complications in patients with diabetes who underwent kidney transplantation: a comparison between kidney-pancreas and kidney-alone transplantation.
BACKGROUND
The aim of this study was to evaluate the effects of islet transplantation on patient survival and diabetic vascular complications.


METHODS
Thirty-seven type 1 uremic diabetic kidney transplant patients underwent islet transplantation (KI group). Uremic type 1 diabetic kidney-pancreas (KP group, n=162), kidney-alone (KD group, n=42) transplant patients, and uremic type 1 diabetic patients still on hemodialysis (HD+DM group, n=196) constituted the control groups for survival and endothelial morphology.


RESULTS
Patient survival was similar in the KI and KP groups and higher than in the HD+DM group (P<0.05). Patients experiencing long-term islet function (KI-successful [KI-s], n=24) showed a better survival (100%, 100%, and 90%) than those in the KI group who lost islet function (KI-unsuccessful [KI-u], n=13) (84%, 75%, and 45%) at 1, 4 and 7 years, respectively (P=0.02). The cardiovascular death rate for the KI group (18%) was similar to the KD group (19%) but lower when the KI-s group is considered alone (5%), and showed a cardiovascular death rate similar to the KP group (8%). The KI-s group showed a good metabolic profile, with reduction of exogenous insulin requirement and persistent C-peptide secretion, as compared with the KI-u group. The endothelial morphology was evaluated with a skin biopsy obtained in all groups. The KI-s and the KP groups demonstrated decreased signs of endothelial injury compared with the KI-u and HD+DM groups. The KI group showed a better atherothrombotic profile than the HD+DM group, with higher levels of natural anticoagulant protein.


CONCLUSIONS
Successful islet transplantation improves survival, atherothrombotic profile, and endothelial morphology in uremic type 1 diabetic kidney transplant patients.
Fiorina
Paolo
P
Department of Medicine I, San Raffaele Hospital, Milan, Italy.
Folli
Franco
F
Maffi
Paola
P
Placidi
Claudia
C
Venturini
Massimo
M
Finzi
Giovanna
G
Bertuzzi
Federico
F
Davalli
Alberto
A
D'Angelo
Armando
A
Socci
Carlo
C
Gremizzi
Chiara
C
Orsenigo
Elena
E
La Rosa
Stefano
S
Ponzoni
Maurilio
M
Cardillo
Massimo
M
Scalamogna
Mario
M
Del Maschio
Alessandro
A
Capella
Carlo
C
Di Carlo
Valerio
V
Secchi
Antonio
A
D000328:Adult; D000990:Antithrombin III / Q000032:analysis; D001161:Arteriosclerosis / Q000209:etiology; D001706:Biopsy; D002318:Cardiovascular Diseases / Q000401:mortality; D003922:Diabetes Mellitus, Type 1; D003925:Diabetic Angiopathies / Q000601:surgery*; D006801:Humans; D016381:Islets of Langerhans Transplantation; D007668:Kidney / Q000503:physiopathology; D016030:Kidney Transplantation; D008875:Middle Aged; D011486:Protein C / Q000032:analysis; D012307:Risk Factors; D012867:Skin / Q000473:pathology; D016019:Survival Analysis; D013927:Thrombosis / Q000209:etiology
D011486:Protein C; D000990:Antithrombin III