Long-term (5 years) efficacy and safety of pancreas transplantation alone in type 1 diabetic patients.
BACKGROUND
Although combined pancreas and kidney transplantation is an established procedure for the treatment of type 1 diabetes (T1D) in patients with end-stage renal disease, the role of pancreas transplant alone (PTA) in the therapy of T1D subjects with preserved kidney function is still matter of debate.


METHODS
We report our single-center experience of PTA in 71 consecutive T1D patients all with a posttransplant follow-up of 5 years. Patient and pancreas (normoglycemia in the absence of any antidiabetic therapy) survivals were determined, and several clinical parameters (including risk factors for cardiovascular diseases) were assessed. Cardiac evaluation and Doppler echocardiographic examination were also performed, and renal function and proteinuria were evaluated.


RESULTS
Actual patient and pancreas survivals at 5 years were 98.6% and 73.2%, respectively. Relaparotomy was needed in 18.3% of cases. Restoration of endogenous insulin secretion was accompanied by sustained normalization of fasting plasma glucose concentrations and HbA1c levels as well as significant improvement of total cholesterol, low-density lipoprotein-cholesterol, and blood pressure. An improvement of left ventricular ejection fraction was also observed. Proteinuria (24 hours) decreased significantly after transplantation. One patient developed end-stage renal disease. In the 51 patients with sustained pancreas graft function, kidney function (serum creatinine and glomerular filtration rate) decreased over time with a slower decline in recipients with pretransplant glomerular filtration rate less than 90 mL/min.


CONCLUSIONS
PTA was an effective and reasonably safe procedure in this single-center cohort of T1D patients.
Division of General and Transplant Surgery in Uremic and Diabetic Patients, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy. u.boggi@med.unipi.it
Ugo
U
Boggi
Fabio
F
Vistoli
Gabriella
G
Amorese
Rosa
R
Giannarelli
Alberto
A
Coppelli
Rita
R
Mariotti
Lorenzo
L
Rondinini
Massimiliamo
M
Barsotti
Stefano
S
Signori
Nelide
N
De Lio
Margherita
M
Occhipinti
Emanuela
E
Mangione
Diego
D
Cantarovich
Stefano
S
Del Prato
Franco
F
Mosca
Piero
P
Marchetti
D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure / Q000502:physiology; D002784:Cholesterol / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000601:surgery*; D015150:Echocardiography, Doppler; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007328:Insulin / Q000378:metabolism; D000078790:Insulin Secretion; D007668:Kidney / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000502:physiology; D016035:Pancreas Transplantation / Q000502:physiology*; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D013534:Survival
D001786:Blood Glucose; D002784:Cholesterol; D008078:Cholesterol, LDL; D003404:Creatinine; D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human