title: Glycemic Control in Simultaneous Islet-Kidney Versus Pancreas-Kidney Transplantation in Type 1 Diabetes: A Prospective 13-Year Follow-up.
abstract: OBJECTIVE
  In patients with type 1 diabetes and end-stage renal disease, combined transplantation of a kidney together with a pancreas or isolated pancreatic islets are options to improve glycemic control. The aim of this study was to compare their long-term outcome with regard to metabolic control and surgical complication rate, as well as function of the transplanted kidney.
  
  
  METHODS
  We conducted a prospective cohort study in consecutive patients receiving either a pancreas or islet transplant simultaneously with or after kidney transplantation (simultaneous pancreas-kidney [SPK]/pancreas-after-kidney [PAK] or simultaneous islet-kidney [SIK]/islet-after-kidney [IAK] transplantation).
  
  
  RESULTS
  Ninety-four patients who had undergone SPK/PAK transplantation were compared with 38 patients who had undergone SIK/IAK transplantation over a period of up to 13 years. HbA1c levels declined from 7.8 ± 1.3% (62 ± 14 mmol/mol) to 5.9 ± 1.1% (41 ± 12 mmol/mol), and from 8.0 ± 1.3% (64 ± 14 mmol/mol) to 6.5 ± 1.1% (48 ± 12 mmol/mol), respectively, in the SPK/PAK and SIK/IAK groups (P < 0.001 for both) and remained stable during follow-up, despite a reduction in the rate of severe hypoglycemia by >90%. The 5-year insulin independence rate was higher in the SPK/PAK group (73.6 vs. 9.3% in the SIK/IAK group), as was the rate of relaparotomy after transplantation (41.5 vs. 10.5% in the SIK/IAK group). There was no difference in the rate of kidney function decline.
  
  
  CONCLUSIONS
  During a long-term follow-up, SPK/PAK transplantation as well as SIK/IAK transplantation resulted in a sustained improvement of glycemic control with a slightly higher glycated hemoglobin level in the SIK/IAK group. While insulin independence is more common in whole-organ pancreas recipients, islet transplantation can be conducted with a much lower surgical complication rate and no difference in kidney function decline.
authors: Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland.
authors: Roger
authors: R
authors: Lehmann
authors: Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland.
authors: Jessica
authors: J
authors: Graziano
authors: Division of Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.
authors: Jens
authors: J
authors: Brockmann
authors: Division of Radiology, University Hospital Zurich, Zurich, Switzerland.
authors: Thomas
authors: T
authors: Pfammatter
authors: Division of Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.
authors: Philipp
authors: P
authors: Kron
authors: Division of Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.
authors: Olivier
authors: O
authors: de Rougemont
authors: Division of Nephrology, University Hospital Zurich, Zurich, Switzerland.
authors: Thomas
authors: T
authors: Mueller
authors: Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland.
authors: Richard A
authors: RA
authors: Zuellig
authors: Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland.
authors: Giatgen A
authors: GA
authors: Spinas
authors: Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland philipp.gerber@usz.ch.
authors: Philipp A
authors: http://orcid.org/0000-0002-2476-7076
authors: PA
authors: Gerber
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000378:metabolism / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016381:Islets of Langerhans Transplantation; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose