Altered kidney graft high-energy phosphate metabolism in kidney-transplanted end-stage renal disease type 1 diabetic patients: a cross-sectional analysis of the effect of kidney alone and kidney-pancreas transplantation.
OBJECTIVE
Diabetes, hypertension, dyslipidemia, obesity, nephrotoxicity of certain immunosuppressive drugs, and the persistence of a chronic alloimmune response may significantly affect graft survival in end-stage renal disease (ESRD) type 1 diabetic patients who have undergone kidney transplant. The aim of this study was to ascertain the impact of kidney alone (KD) or combined kidney-pancreas (KP) transplantation on renal energy metabolism.


METHODS
We assessed high-energy phosphates (HEPs) metabolism by using, in a cross-sectional fashion, 31P-magnetic resonance spectroscopy in the graft of ESRD type 1 diabetic transplanted patients who received KD (n = 20) or KP (n = 20) transplant long before the appearance of overt chronic allograft nephropathy (CAN). Ten nondiabetic microalbuminuric kidney transplanted patients and 10 nondiabetic kidney transplanted patients with overt CAN were chosen as controls subjects.


RESULTS
Simultaneous KP transplantation patients showed a higher beta-ATP/inorganic phosphorus (Pi) ratio (marker of the graft energy status) versus the other groups, and a positive correlation between beta-ATP/Pi phosphorus ratio and A1C was found. In the analysis limited to the subgroup of normoalbuminuric patients, the difference in beta-ATP/Pi was still detectable in KP patients compared with KD transplantation.


CONCLUSIONS
KP transplantation was associated with better HEPs than in KD transplantation, suggesting that restoration of beta-cell function positively affects kidney graft metabolism.
Fiorina
Paolo
P
Department of Medicine, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy. paolo.fiorina@hsr.it
Perseghin
Gianluca
G
De Cobelli
Francesco
F
Gremizzi
Chiara
C
Petrelli
Alessandra
A
Monti
Lucilla
L
Maffi
Paola
P
Luzi
Livio
L
Secchi
Antonio
A
Del Maschio
Alessandro
A
D000328:Adult; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000378:metabolism / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000378:metabolism / Q000601:surgery*; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D050417:Insulin-Secreting Cells / Q000502:physiology; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000601:surgery*; D016030:Kidney Transplantation / Q000276:immunology / Q000473:pathology / Q000502:physiology*; D009682:Magnetic Resonance Spectroscopy; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000276:immunology / Q000502:physiology*; D010710:Phosphates / Q000378:metabolism*; D014184:Transplantation, Homologous
D002784:Cholesterol; D006442:Glycated Hemoglobin; D010710:Phosphates