The comparison of treatment results of type 1 diabetes mellitus complicated by end-stage diabetic nephropathy in patients undergoing simultaneous pancreas and pre-emptive kidney transplantation (SPPkTx) and patients enrolled into the dialysis program--a cohort study.
OBJECTIVE
A cohort study was conducted to compare treatment of patients with type 1 diabetes mellitus and end-stage diabetic nephropathy.


METHODS
47 type 1 diabetic patients required renal replacement therapy in years: 2001-2005 were enrolled. Simultaneous pancreas and preemptive kidney transplant (sppktx) was performed in 18 (group I). Group II consisted of 29 patients who entered dialysis program. Survival rate for patients from both groups was estimated. Transplanted organ function was evaluated for group II. Lipid profile and its correlation with thickness of carotid media was assessed. Impact of sppktx on diabetic retinopathy was investigated. Cost and life quality were compared between groups.


RESULTS
Two-year cumulative recipient survival rate for group I and II was 100% and 96%, respectively. One-year cumulative survival rate for transplanted pancreas was 88% and for kidney grafts 94%. In group I cholesterol and triglyceride level before transplantation were: 207 +/- 38 mg/dl and 133 +/- 65 mg/dl and decreased after transplantation to 155 +/- 20 mg/dl and 78 +/- 25 mg/dl, respectively (p < 0.05). No difference of carotid media thickness was observed between groups. Stabilization of retinopathy was observed in 91.6% non-blind recipients. During the first year of the follow-up the costs of transplantation doubled those of dialysis therapy but in the second year the costs of dialysis exceeded the costs required for transplanted patients.


CONCLUSIONS
Despite of major surgery and introduction of immunosuppression in group I, results did not differ significantly between groups during a two-year follow-up. After sppktx, stabilization of the carotid media was slower than the normalization of lipids. At the second year, transplantation is less expensive than dialysis.
Grochowiecki
Tadeusz
T
Department of General, Vascular and Transplant Surgery, The Medical University of Warsaw. trgroch@amwaw.edu.pl
Szmidt
Jacek
J
Gałazka
Zbigniew
Z
Nazarewski
Sławomir
S
Madej
Krzysztof
K
Frunze
Sławomir
S
Wyzgał
Janusz
J
Senatorski
Grzegorz
G
Jakimowicz
Tomasz
T
Pietrasik
Kamil
K
Wojtaszek
Mikołaj
M
Grygiel
Katarzyna
K
Chudziński
Witold
W
Siciński
Marcin
M
Kański
Andrzej
A
Paczek
Leszek
L
D000328:Adult; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000401:mortality / Q000628:therapy*; D003928:Diabetic Nephropathies / Q000150:complications / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D006435:Renal Dialysis; D015996:Survival Rate; D016896:Treatment Outcome
D007004:Hypoglycemic Agents; D007328:Insulin