Normalization of multiple hemostatic abnormalities in uremic type 1 diabetic patients after kidney-pancreas transplantation.
To evaluate the effects of kidney-pancreas transplantation on hemostatic abnormalities in uremic type 1 diabetic patients, we conducted a cross-sectional study involving 12 type 1 diabetic patients, 30 uremic type 1 diabetic patients, 27 uremic type 1 diabetic patients who had a kidney-pancreas transplant, 12 uremic type 1 diabetic patients who had a kidney-alone transplant, and 13 healthy control subjects. We evaluated platelet and clotting system. Platelets in the group of uremic type 1 diabetic patients were significantly larger than platelets in the other groups. Resting calcium levels were significantly higher in the uremic type 1 diabetic patients and uremic type 1 diabetic patients who had a kidney-alone transplant than in the type 1 diabetic patients who had a kidney-pancreas transplant and control subjects. CD41 expression was significantly reduced in platelets from the uremic type 1 diabetic patients compared with the other groups. Levels of hypercoagulability markers in the type 1 diabetic patients who had a kidney-pancreas transplant and, to a lesser extent, the uremic type 1 diabetic patients who had a kidney-alone transplant but not the uremic type 1 diabetic patients were similar to those of the control subjects. A reduction in natural anticoagulants was evident in the uremic type 1 diabetic patients, whereas near-normal values were observed in the type 1 diabetic patients who had a kidney-pancreas transplant and uremic type 1 diabetic patients who had a kidney-alone transplant. Hemostatic abnormalities were not observed in type 1 diabetic patients who had a kidney-pancreas transplant. This finding might explain the lower cardiovascular death rate observed in type 1 diabetic patients who had a kidney-pancreas transplant compared with uremic type 1 diabetic patients who had a kidney-alone transplant or uremic type 1 diabetic patients.
Internal Medicine, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy.
Paolo
P
Fiorina
Franco
F
Folli
Armando
A
D'Angelo
Giovanna
G
Finzi
Fabio
F
Pellegatta
Valeria
V
Guzzi
Carlo
C
Fedeli
Patrizia
P
Della Valle
Luciana
L
Usellini
Claudia
C
Placidi
Francesco
F
Bifari
Daniela
D
Belloni
Elisabetta
E
Ferrero
Carlo
C
Capella
Antonio
A
Secchi
D000328:Adult; D001777:Blood Coagulation; D001778:Blood Coagulation Disorders / Q000097:blood / Q000150:complications*; D001792:Blood Platelets / Q000378:metabolism; D002118:Calcium / Q000378:metabolism; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications / Q000601:surgery; D003928:Diabetic Nephropathies / Q000097:blood / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D010314:Partial Thromboplastin Time; D040201:Platelet Membrane Glycoprotein IIb / Q000378:metabolism; D011517:Prothrombin Time; D044463:Receptor, PAR-1 / Q000378:metabolism; D018179:Receptors, Thrombin / Q000378:metabolism; D015398:Signal Transduction; D014511:Uremia / Q000097:blood* / Q000150:complications / Q000601:surgery
D040201:Platelet Membrane Glycoprotein IIb; D044463:Receptor, PAR-1; D018179:Receptors, Thrombin; C105295:protease-activated receptor 3; D002118:Calcium