title: Results of pancreas transplantation alone with special attention to native kidney function and proteinuria in type 1 diabetes patients.
abstract: We report on our single-center experience with pancreas transplantation alone (PTA) in 71 patients with type 1 diabetes, and a 4-year follow-up. Portal insulin delivery was used in 73.2% of cases and enteric drainage of exocrine secretion in 100%. Immunosuppression consisted of basiliximab (76%), or thymoglobulin (24%), followed by mycophenolate mofetil, tacrolimus, and low-dose steroids. Actuarial patient and pancreas survival at 4 years were 98.4% and 76.7%, respectively. Relaparatomy was needed in 18.3% of patients. Restored endogenous insulin secretion resulted in sustained normalization of fasting plasma glucose levels and HbA1c concentration in all technically successful transplantations. Protenuria (24-hour) improved significantly after PTA. Renal function declined only in recipients with pretransplant glomerular filtration rate (GFR) greater than 90 ml/min, possibly as a result of correction of hyperfiltration following normalization of glucose metabolism. Further improvements were recorded in several cardiovascular risk factors, retinopathy, and neuropathy. We conclude that PTA was an effective and reasonably safe procedure in this single-center experience.
authors.affiliation: Division of General and Transplant Surgery in Uremic and Diabetic Patients, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy. uboggi@patchir.med.unipi.it
authors.forename: Ugo
authors.initials: U
authors.lastname: Boggi
authors.forename: Fabio
authors.initials: F
authors.lastname: Vistoli
authors.forename: Gabriella
authors.initials: G
authors.lastname: Amorese
authors.forename: Rosa
authors.initials: R
authors.lastname: Giannarelli
authors.forename: Alberto
authors.initials: A
authors.lastname: Coppelli
authors.forename: Rita
authors.initials: R
authors.lastname: Mariotti
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Rondinini
authors.forename: Massimiliamo
authors.initials: M
authors.lastname: Barsotti
authors.forename: Alberto
authors.initials: A
authors.lastname: Piaggesi
authors.forename: Anna
authors.initials: A
authors.lastname: Tedeschi
authors.forename: Stefano
authors.initials: S
authors.lastname: Signori
authors.forename: Nelide
authors.initials: N
authors.lastname: De Lio
authors.forename: Margherita
authors.initials: M
authors.lastname: Occhipinti
authors.forename: Emanuela
authors.initials: E
authors.lastname: Mangione
authors.forename: Diego
authors.initials: D
authors.lastname: Cantarovich
authors.forename: Stefano
authors.initials: S
authors.lastname: Del Prato
authors.forename: Franco
authors.initials: F
authors.lastname: Mosca
authors.forename: Piero
authors.initials: P
authors.lastname: Marchetti
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000503:physiopathology / Q000601:surgery* / Q000652:urine*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000379:methods* / Q000592:standards
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin