Metabolic results 3 years after simultaneous pancreas-kidney transplantation.
BACKGROUND
Simultaneous pancreas-kidney (SPK) transplantation has become accepted therapy for patients with type 1 diabetes and end-stage renal disease. This 3-year study compared the metabolic effects of tacrolimus- and cyclosporin microemulsion (ME)-based immunosuppressive therapy in this clinical setting.


METHODS
The study population comprised the 205 patients enrolled in the Euro-SPK 001 study. Glucose metabolism parameters [fasting blood glucose, fasting C-peptide and glycated haemoglobin (HbA1c)], blood lipids (total cholesterol and triglycerides) and pancreatic enzymes (lipase and amylase) were monitored at regular intervals during the study. Blood pressure was also carefully monitored and compared with target levels for diabetic patients.


RESULTS
Fasting C-peptide and HbA1c levels were within the normal ranges in the two treatment groups throughout the 3 years. Fasting blood glucose was higher during the first 2 months post-transplant in the tacrolimus group than in the cyclosporin-ME group, but no differences were seen thereafter. From month 2 post-transplant, mean levels of total cholesterol were significantly lower among patients receiving tacrolimus than among those in the cyclosporin-ME group. In addition, patients receiving cyclosporin-ME showed serological features of mild pancreatitis, with elevated blood amylase and lipase levels during the first 6 months post-transplant. The two regimens were comparable with respect to hypertension.


CONCLUSIONS
Except for lipid profiles, no major differences in metabolic effects or blood pressure control were observed over the 3 years in SPK transplant patients receiving immunosuppression based on tacrolimus or cyclosporin-ME. In view of the potential risk of hypertension, antihypertensive strategies should be implemented for all patients.
Secchi
Antonio
A
Department of Internal Medicine, Vita Salute San Raffaele University, Milan, Italy.
Malaise
Jacques
J
Caldara
Rossana
R
D000681:Amylases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000601:surgery; D003928:Diabetic Nephropathies / Q000097:blood / Q000150:complications / Q000601:surgery; D005060:Europe; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006084:Graft Rejection / Q000097:blood / Q000517:prevention & control; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007557:Israel; D007676:Kidney Failure, Chronic / Q000097:blood / Q000209:etiology / Q000601:surgery; D016030:Kidney Transplantation; D008049:Lipase / Q000097:blood; D008055:Lipids / Q000097:blood*; D016035:Pancreas Transplantation; D011184:Postoperative Period; D013997:Time Factors
D000681:Amylases; D015415:Biomarkers; D001786:Blood Glucose; D002097:C-Reactive Protein; D006442:Glycated Hemoglobin; D007166:Immunosuppressive Agents; D008049:Lipase; D008055:Lipids