Quality of life improvement and long-term effects of peripheral blood mononuclear cell transplantation for severe arteriosclerosis obliterans in diabetic patients on dialysis.
BACKGROUND
Severe arteriosclerosis obliterans (ASO) can be intractable, especially in diabetic patients on hemodialysis (HD). Recently, the transplantation of autologous peripheral blood mononuclear cells (PBMNCs) has been reported to have beneficial effects, but the long-term effects and impact on quality of life (QOL) have not been studied.


RESULTS
Autologous PBMNCs were transplanted into 7 diabetic patients on HD who had severe ASO (5 cases with Fontaine IV and 2 with Fontaine III) after administration of 5 microg/kg granulocyte colony stimulating factor; QOL and degree of ischemia was assessed by measuring skin temperature, skin perfusion pressure (SPP), ankle-brachial index (ABI), and ulcer size, and from angiographic findings. At 4 weeks after the procedure, skin temperature was significantly improved, and SPP and ABI also were increased. These beneficial effects persisted for up to 24 weeks. Angiographic findings and ulcer size improved in 3 of 7 and 3 of 4 patients, respectively. SF-36v2 analysis revealed significant improvements in pain scores. No serious complications were detected.


CONCLUSIONS
Transplantation of PBMNCs resulted in improvement in pain and leg ischemia for over 6 months without serious complications. This therapy is safe and effective for severe ASO in diabetic patients on HD.
Hoshino
Junichi
J
Nephrology Center, Department of Plastic Surgery, Toranomon Hospital, Tokyo, Japan. hoshino@toranomon.gr.jp
Ubara
Yoshifumi
Y
Hara
Shigeko
S
Sogawa
Yoko
Y
Suwabe
Tatsuya
T
Higa
Yasushi
Y
Nakanishi
Shohei
S
Sawa
Naoki
N
Katori
Hideyuki
H
Takemoto
Fumi
F
Fujimoto
Yo
Y
Ohta
Eiichi
E
Ohara
Kanetoshi
K
Takaichi
Kenmei
K
D000368:Aged; D001162:Arteriosclerosis Obliterans / Q000473:pathology / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000628:therapy; D005260:Female; D006801:Humans; D007511:Ischemia; D007866:Leg / Q000473:pathology; D007963:Leukocytes, Mononuclear / Q000637:transplantation; D008297:Male; D008875:Middle Aged; D010146:Pain; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods*; D011788:Quality of Life; D006435:Renal Dialysis; D016896:Treatment Outcome; D014456:Ulcer