title: In patients with type 1 diabetes simultaneous pancreas and kidney transplantation preserves long-term kidney graft ultrastructure and function better than transplantation of kidney alone.
abstract: OBJECTIVE
  In patients with type 1 diabetes and end-stage renal disease (ESRD) we aimed to determine whether long-term normoglycaemia, as achieved by successful simultaneous pancreas and kidney (SPK) transplantation, would preserve kidney graft structure and function better than live donor kidney (LDK) transplantation alone.
  
  
  METHODS
  Estimated GFR (eGFR) was calculated in SPK (n = 25) and LDK (n = 17) recipients in a stable phase 3 months after transplantation and annually during follow-up. Kidney graft biopsies were obtained at follow-up for measurement of glomerular volume (light microscopy), glomerular basement membrane (GBM) and podocyte foot process widths and mesangial volume fraction (electron microscopy).
  
  
  RESULTS
  SPK and LDK recipients were similar in age and diabetes duration at engraftment. Donor age was higher in the LDK group. Median follow-up time was 10.1 years. Mean HbA1c levels during follow-up were 5.5 ± 0.4% (37 ± 5 mmol/mol) and 8.3 ± 1.5% (68 ± 16 mmol/mol) in the SPK and LDK group, respectively (p < 0.001). Compared with SPK recipients, LDK recipients had wider GBM (369 ± 109 nm vs 281 ± 57 nm; p = 0.008) and increased mesangial volume fraction (median 0.23 [range 0.13-0.59] vs 0.16 [0.10-0.41]; p = 0.007) at follow-up. Absolute eGFR change from baseline was -11 ± 21 and -23 ± 15 ml min(-1) 1.73 m(-2) (p = 0.060), whereas eGFR slope was -1.1 (95% CI -1.7, -0.5) and -2.6 (95% CI -3.1, -2.1) ml min(-1) 1.73 m(-2) per year in the SPK and LDK group, respectively (p = 0.001).
  
  
  CONCLUSIONS
  In patients with type 1 diabetes and long-term normoglycaemia after successful SPK transplantation, kidney graft ultrastructure and function were better preserved compared with LDK transplantation alone.
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Oslo, Norway, j.p.h.lindahl@medisin.uio.no.
authors.forename: Jørn P
authors.initials: JP
authors.lastname: Lindahl
authors.forename: Finn P
authors.initials: FP
authors.lastname: Reinholt
authors.forename: Ivar A
authors.initials: IA
authors.lastname: Eide
authors.forename: Anders
authors.initials: A
authors.lastname: Hartmann
authors.forename: Karsten
authors.initials: K
authors.lastname: Midtvedt
authors.forename: Hallvard
authors.initials: H
authors.lastname: Holdaas
authors.forename: Linda T
authors.initials: LT
authors.lastname: Dorg
authors.forename: Trine M
authors.initials: TM
authors.lastname: Reine
authors.forename: Svein O
authors.initials: SO
authors.lastname: Kolset
authors.forename: Rune
authors.initials: R
authors.lastname: Horneland
authors.forename: Ole
authors.initials: O
authors.lastname: Øyen
authors.forename: Knut
authors.initials: K
authors.lastname: Brabrand
authors.forename: Trond
authors.initials: T
authors.lastname: Jenssen
mesh_terms: D000293:Adolescent; D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D016035:Pancreas Transplantation; D016896:Treatment Outcome; D055815:Young Adult