title: Microvascular damage in type 1 diabetic patients is reversed in the first year after simultaneous pancreas-kidney transplantation.
abstract: Simultaneous pancreas-kidney transplantation (SPK) is an advanced treatment option for type 1 diabetes mellitus (DM) patients with microvascular disease including nephropathy. Sidestreamdarkfield (SDF) imaging has emerged as a noninvasive tool to visualize the human microcirculation. This study assessed the effect of SPK in diabetic nephropathy (DN) patients on microvascular alterations using SDF and correlated this with markers for endothelial dysfunction. Microvascular morphology was visualized using SDF of the oral mucosa in DN (n = 26) and SPK patients (n = 38), healthy controls (n = 20), DM1 patients (n = 15, DM ≥ 40 mL/min) and DN patients with a kidney transplant (KTx, n = 15). Furthermore, 21 DN patients were studied longitudinally up to 12 months after SPK. Circulating levels of angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2) and soluble thrombomodulin (sTM) were measured using ELISA. Capillary tortuosity in the DN (1.83 ± 0.42) and DM ≥ 40 mL/min (1.55 ± 0.1) group was increased and showed reversal after SPK (1.31 ± 0.3, p < 0.001), but not after KTx (1.64 ± 0.1). sTM levels were increased in DN patients and reduced in SPK and KTx recipients (p < 0.05), while the Ang-2/Ang-1 ratio was normalized after SPK and not after KTx alone (from 0.16 ± 0.04 to 0.08 ± 0.02, p < 0.05). Interestingly, in the longitudinal study, reversal of capillary tortuosity and decrease in Ang-2/Ang-1 ratio and sTM was observed within 12 months after SPK. SPK is effective in reversing the systemic microvascular structural abnormalities in DN patients in the first year after transplantation.
authors: Department of Nephrology, Leiden University Medical Center, the Netherlands. m.khairoun.nier@lumc.nl
authors: M
authors: M
authors: Khairoun
authors: E J P
authors: EJ
authors: de Koning
authors: B M
authors: BM
authors: van den Berg
authors: E
authors: E
authors: Lievers
authors: H C
authors: HC
authors: de Boer
authors: A F M
authors: AF
authors: Schaapherder
authors: M J K
authors: MJ
authors: Mallat
authors: J I
authors: JI
authors: Rotmans
authors: P J M
authors: PJ
authors: van der Boog
authors: A J
authors: AJ
authors: van Zonneveld
authors: J W
authors: JW
authors: de Fijter
authors: T J
authors: TJ
authors: Rabelink
authors: M E J
authors: ME
authors: Reinders
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000503:physiopathology / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D016035:Pancreas Transplantation; D011184:Postoperative Period; D013997:Time Factors; D016896:Treatment Outcome