A Comparative Analysis of Results and Morbidity in Type I Diabetics Undergoing Preemptive Versus Postdialysis Combined Pancreas-Kidney Transplantation

Rj, Stratta; Rj, Taylor; Cf, Ozaki; Js, Bynon; Sa, Miller; Tf, Knight; Jl, Fischer; Tv, Neumann; To, Wahl; Wc, Duckworth

doi:10.1097/00007890-199305000-00031

Cited by 37 publications

(14 citation statements)

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“…We have previously shown that preemptive PKT can be performed safely and effectively in the absence of uremia, thereby providing the potential for arresting the progression of diabetic complications before the development of end-stage renal disease (15,27). To take the concept of preemptive transplantation one step farther, one could speculate that solitary PTx could be performed before the development of advanced diabetic complications such as the need for a kidney transplant.…”

Section: Conclusion-vascularizedmentioning

confidence: 99%

Solitary Pancreas Transplantation: Experience with 62 consecutive cases

et al. 1997

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Section: Conclusion-vascularizedmentioning

confidence: 99%

Solitary Pancreas Transplantation: Experience with 62 consecutive cases

et al. 1997

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“…2 During the last decade, advances in both surgical technique and immunosuppressive therapy have improved the outcomes of whole-organ pancreas transplantation. [2][3][4][5][6] In the absence of organ rejection, the transplanted pancreas restores euglycemia, achieves insulin independence, and prevents further macrovascular complications related to T1DM. 7 The simultaneous pancreaskidney (SPK) transplantation is the preferred procedure for patients with T1DM and end-stage renal disease.…”

Section: Introductionmentioning

confidence: 99%

Continuous Glucose Monitoring in Subjects After Simultaneous Pancreas-Kidney and Kidney-Alone Transplantation

Rodríguez

Knight

Heptulla

2010

Diabetes Technology & Therapeutics

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Background: Simultaneous pancreas-kidney (SPK) transplantation is an important replacement therapy for individuals with diabetes and end-stage renal disease. Kidney-alone (KA) transplantation is associated with a high incidence of post-transplant diabetes.Methods: This was a cross-sectional study. We studied 48-h glucose concentrations in eight subjects with type 1 diabetes mellitus after SPK transplantation, six subjects post-KA transplantation, and nine healthy controls using the CGMS Ò (Medtronic Minimed, Northridge, CA) continuous glucose monitoring system. Results: The 48-h mean glucose concentration was 101 AE 7 mg=dL in the SPK subjects, 105 AE 12 mg=dL in the KA subjects, and 99 AE 7 mg=dL in the healthy controls. The glycemic excursions were higher in the KA group compared to the SPK cohort and healthy controls (P < 0.0001). No differences in the incidence of hypoglycemia were detected among the three groups. Significant postprandial hyperglycemia was uncovered in four of the six KA subjects. Conclusions: SPK transplantation is very effective at normalizing glycemic excursions. Unsuspected hyperglycemia was identified in the KA group. The CGMS was a useful ambulatory tool to study glucose profiles in the post-transplant period and may help uncover hyperglycemia undetected by routine laboratory testing.

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“…This can be essentially related to the more severe preoperative condition of SPKT patients who, in addition to severe diabetes, are dangerously jeopardized by chronic renal failure [11]. As a consequence, in our series SPKT recipients drugs needed more frequently to treat arterial hypertension (30 SPKT vs. 4 PTA) which, besides being reported to be associated with chronic renal insufficiency, also plays a major role in increasing cardiac risk in patients [12].…”

Section: Discussionmentioning

confidence: 97%

“…Another discrepancy pointed out by our data, although not statistically significant, between SPKT and PTA recipients is their different coagulation profile highlighted by their graft thrombosis rate which was 2.9% and 5.4% respectively (P ¼ 0.5). This discrepency may be explained by the fact that uremic-related coagulopathy may protect SPKT patients against the risk of pancreatic graft (a lowflow organ) thrombosis [11]. Again, the different degree of the preoperative diabetes severity significantly affects the outcome of such a class of patients with the PTA patients showing a more favorable postoperative course from this point of view [15].…”

Section: Discussionmentioning

confidence: 99%

Early morbidity after pancreas transplantation

et al. 2005

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This study aims to evaluate and compare the early outcome of both pancreasalone transplantation (PTA) and simultaneous kidney–pancreas transplantation (SPKT) focusing on the complications affecting the first month after the procedures. The records of all patients who underwent PTA or SPKT were reviewed. We considered the length of ICU stay, the need for postoperative ventilatory support, hemodynamic and metabolic data (arterial pH, serum glucose, need for exogenous insulin), infectious diseases incidence, microbiological colonization rate and any kind of postoperative complication arising during the first month after the transplantation. PTA recipients underwent a quicker surgery (P < 0.01) with shorter ICU stay (P < 0.05) and a lower need for postoperative mechanical ventilation (P < 0.05). They also had a higher hemodynamic stability (P < 0.05) with less cardiological complications (P < 0.05) in the intraand postoperative phases; bacterial colonisation was also less frequent in PTA recipients (P < 0.05). On the contrary, no significant difference was noted with regard to postoperative nausea/vomiting, sudden myocardial death, ICU re-admissions, graft function, rate of rejection, grafts explantation and re-transplantation. PTA could be considered as preemptive for severe diabetic complications in patients with long-lasting severe type I diabetes. However, establishing the correct timing of PTA is of paramount importance in order not to expose the patients early to risks arising from a major surgery and heavy immunosuppressive treatments

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A Comparative Analysis of Results and Morbidity in Type I Diabetics Undergoing Preemptive Versus Postdialysis Combined Pancreas-Kidney Transplantation

Cited by 37 publications

References 0 publications

Solitary Pancreas Transplantation: Experience with 62 consecutive cases

Solitary Pancreas Transplantation: Experience with 62 consecutive cases

Continuous Glucose Monitoring in Subjects After Simultaneous Pancreas-Kidney and Kidney-Alone Transplantation

Early morbidity after pancreas transplantation

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