title: Near normalization of metabolic and functional features of the central nervous system in type 1 diabetic patients with end-stage renal disease after kidney-pancreas transplantation.
abstract: OBJECTIVE
  The pathogenesis of brain disorders in type 1 diabetes (T1D) is multifactorial and involves the adverse effects of chronic hyperglycemia and of recurrent hypoglycemia. Kidney-pancreas (KP), but not kidney alone (KD), transplantation is associated with sustained normoglycemia, improvement in quality of life, and reduction of morbidity/mortality in diabetic patients with end-stage renal disease (ESRD).
  
  
  METHODS
  The aim of our study was to evaluate with magnetic resonance imaging and nuclear magnetic resonance spectroscopy ((1)H MRS) the cerebral morphology and metabolism of 15 ESRD plus T1D patients, 23 patients with ESRD plus T1D after KD (n = 9) and KP (n = 14) transplantation, and 8 age-matched control subjects.
  
  
  RESULTS
  Magnetic resonance imaging showed a higher prevalence of cerebrovascular disease in ESRD plus T1D patients (53% [95% CI 36-69]) compared with healthy subjects (25% [3-6], P = 0.04). Brain (1)H MRS showed lower levels of N-acetyl aspartate (NAA)-to-choline ratio in ESRD plus T1D, KD, and KP patients compared with control subjects (control subjects vs. all, P < 0.05) and of NAA-to-creatine ratio in ESRD plus T1D compared with KP and control subjects (ESRD plus T1D vs. control and KP subjects, P ≤ 0.01). The evaluation of the most common scores of psychological and neuropsychological function showed a generally better intellectual profile in control and KP subjects compared with ESRD plus T1D and KD patients.
  
  
  CONCLUSIONS
  Diabetes and ESRD are associated with a precocious form of brain impairment, chronic cerebrovascular disease, and cognitive decline. In KP-transplanted patients, most of these features appeared to be near normalized after a 5-year follow-up period of sustained normoglycemia.
authors.affiliation: Nephrology Division, Transplantation Research Center, Children's Hospital, Brigham andWomen's Hospital, Harvard Medical School, Boston, Massachusetts, USA. paolo.fiorina@childrens.harvard.edu
authors.forename: Paolo
authors.initials: P
authors.lastname: Fiorina
authors.forename: Paolo
authors.initials: P
authors.lastname: Vezzulli
authors.forename: Roberto
authors.initials: R
authors.lastname: Bassi
authors.forename: Chiara
authors.initials: C
authors.lastname: Gremizzi
authors.forename: Monica
authors.initials: M
authors.lastname: Falautano
authors.forename: Francesca
authors.initials: F
authors.lastname: D'Addio
authors.forename: Andrea
authors.initials: A
authors.lastname: Vergani
authors.forename: Lola
authors.initials: L
authors.lastname: Chabtini
authors.forename: Erica
authors.initials: E
authors.lastname: Altamura
authors.forename: Alessandra
authors.initials: A
authors.lastname: Mello
authors.forename: Rossana
authors.initials: R
authors.lastname: Caldara
authors.forename: Marina
authors.initials: M
authors.lastname: Scavini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Magnani
authors.forename: Andrea
authors.initials: A
authors.lastname: Falini
authors.forename: Antonio
authors.initials: A
authors.lastname: Secchi
mesh_terms: D000328:Adult; D002490:Central Nervous System / Q000473:pathology*; D003922:Diabetes Mellitus, Type 1 / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D016030:Kidney Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation