Carotid intima media thickness decreases after pancreas transplantation1

Larsen, Jennifer L.; Ratanasuwan, Tanaporn; Burkman, Tab; Lynch, Thomas G.; Erickson, J K; Colling, Christopher; Lane, James T.; Mack-Shipman, Lynn; Lyden, Elizabeth; Loseke, Melissa; Miller, Suzanne; Leone, John P.

doi:10.1097/00007890-200203270-00019

Cited by 49 publications

(12 citation statements)

References 29 publications

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“…Jukema et al reported that there was regression of coronary artery atherosclerosis in 38% of successful pancreas transplants, but in none of the patients in whom the pancreas transplant had failed [17] with similar results reported by Larsen et al [18]. With islet transplantation, the Milan group demonstrated a decrease of carotid intimal thickness (À73 AE 30 mm) over a 1-to 3-year period vs. progression (þ245 AE 20 mm), if the islet transplant was not successful [19].…”

Section: Vascularsupporting

confidence: 70%

Current indications for pancreas or islet transplant

Ryan

Bigam

Shapiro

2004

Diabetes Obesity Metabolism

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Pancreas or islet transplantation can provide good glycaemic control and insulin independence. Pancreas transplantation has been associated with improvement in diabetic retinopathy, nephropathy, neuropathy and vasculopathy, but has the associated morbidity of major surgery. Both forms of therapy require long-term immunosuppression and its attendant risks and both achieve insulin independence rates of about 80% at 1 year. Pancreas transplantation at the same time as a renal transplant is a worthwhile option to employ, especially if the diabetes has been difficult to control. Diabetes associated with frequent severe hypoglycaemia or extreme lability, despite optimization of diabetes management, may benefit from either pancreas or islet transplant alone with the latter being the lower-risk procedure. More quantitative measures of hypoglycaemia and lability are now available to facilitate the assessment of the severity of these problems with glucose control. Diabetic patients with renal involvement (macroproteinuria, but no major elevation of creatinine) and unstable diabetes may be helped with an islet or pancreas transplant, but this approach should still be considered experimental and such a transplant may hasten the need for renal replacement therapy. In the setting of well-controlled diabetes and intact renal function, it is difficult to justify pancreas or islet transplant alone given the risks of immunosuppression.

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Section: Vascularsupporting

confidence: 70%

Current indications for pancreas or islet transplant

Ryan

Bigam

Shapiro

2004

Diabetes Obesity Metabolism

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“…We have previously shown that candidates for PTX have greater carotid IMT than age-matched normal control subjects (12) and that carotid IMT was lower after PTX in a cross-sectional study (4). However, this is the first prospective study of carotid IMT in pancreas transplant recipients to show improved carotid IMT after PTX.…”

Section: Discussionmentioning

confidence: 69%

“…Both carotid arteries were examined using an ATL Ultramark 9 ultrasound system (Advanced Technology Laboratories, Bothel, WA) with a video recording of the distal 10 -30 mm of the left and right common carotid arteries, as previously described (4). All images were analyzed by a single reader, who was blinded to the status or identity of the individual.…”

Section: Carotid Ultrasonographymentioning

confidence: 99%

Pancreas Transplantation Improves Vascular Disease in Patients With Type 1 Diabetes

et al. 2004

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OBJECTIVE -Pancreas transplantation (PTX) normalizes glucose and improves microvascular complications, but its impact on macrovascular disease is still debated. RESEARCH DESIGN AND METHODS -Carotid intima-media thickness (IMT),shown to correlate with cardiovascular disease (CVD) risk and events, was determined prospectively by ultrasonography in successful pancreas transplant recipients to evaluate the effect of PTX on CVD risk. Carotid IMT and CVD risk factors of pancreas transplant recipients (n ϭ 25) were compared with three groups: individuals with type 1 diabetes without significant nephropathy (n ϭ 20), nondiabetic kidney transplant recipients (n ϭ 16), and normal control subjects (n ϭ 32). Mean age of pancreas transplant recipients at the time of transplantation was 42.4 Ϯ 1.2 years (mean Ϯ SE) and duration of diabetes was 25.9 Ϯ 1.4 years. RESULTS-After PTX, HbA 1c level (P Ͻ 0.0001) decreased to normal and, whereas creatinine level (P ϭ 0.0002) decreased, it remained elevated compared with normal control subjects (P Ͻ 0.05). Blood pressure, BMI, fasting lipid levels, smoking frequency, and use of hypolipidemic agents were unchanged. Mean carotid IMT was increased in pancreas transplant candidates but decreased by 1.8 Ϯ 0.1 year after PTX (P ϭ 0.0068), no longer different from that in normal control subjects or patients with type 1 diabetes.CONCLUSIONS -Carotid IMT improves after successful PTX within 2 years of the procedure, with normalization of HbA 1c and improved renal function, independent of changes in lipid levels, BMI, blood pressure, smoking, or use of hypolipidemic agents. This study suggests that CVD risk, future events, and mortality should improve after PTX in the absence of other significant, untreated CVD risk factors. Diabetes Care 27:1706 -1711, 2004C ardiovascular disease (CVD) is the most common cause of mortality in patients with diabetes. Pancreas transplantation (PTX) normalizes glucose levels far better than any other strategy available for treatment of type 1 diabetes (1). Improvement in glucose levels reduces risk of microvascular complications in type 1 and type 2 diabetes and reduces macrovascular disease events in type 2 diabetes (2,3). Whether normalization of glucose can reduce CVD in type 1 diabetes, or whether PTX can reverse CVD in type 1 diabetes after it has occurred, is not as well established. Carotid intima-media thickness (IMT) correlates with risk and future CVD events. This is the first prospective study of carotid IMT in pancreas transplant recipients to determine whether PTX changes overall CVD risk. RESEARCH DESIGN AND METHODS PTX candidatesPatients with type 1 diabetes being evaluated for PTX who agreed to participate underwent baseline carotid ultrasonography at transplant evaluation and again at least 1 year after PTX if graft function was normal. Normal graft function was defined as HbA 1c Յ6.5% (as defined by the clinical laboratory at the time of this study) and serum creatinine level Յ2.4 mg/dl. All PTX procedures were accomplished using whole-organ gra...

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“…The use of intravital microscopy showed significant quantitative improvement in the conjunctival microcirculation of 12 SPK recipients when compared with five KTA recipients [36]. Improvement in carotid intima-media thickness (CIMT), shown to correlate with cardiovascular disease risk and events, has also been described in pancreas transplant recipients within 2 years of the procedure, independent of changes in lipid levels, BMI, blood pressure, or smoking [37,38]. Successful SPK transplantation has also been reported to ameliorate cardiovascular risk factor profiles, reduce the progression of coronary atherosclerosis, improve left ventricular function and improve endothelial function [39][40][41][42][43][44].…”

Section: Cardiovascular Systemmentioning

confidence: 97%