2001

DOI: 10.2337/diabetes.50.3.496

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Effects of Kidney-Pancreas Transplantation on Atherosclerotic Risk Factors and Endothelial Function in Patients With Uremia and Type 1 Diabetes

Paolo Fiorina¹,

Massimo Venturini³

et al.

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Cited by 103 publications

(69 citation statements)

References 30 publications

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“…The mean of the right and the left longitudinal common carotid artery IMT measurements was used in the analysis. Intraobserver variability was 0.02 Ϯ 0.02 mm in our group as previously reported (9).…”

Section: Fiorina and Associatessupporting

confidence: 72%

“…The operators measuring IMT, as well as people who read all cardiovascular tests, were blinded on patients' conditions (9). Briefly, ultrasonographic analysis of the carotid artery was done with a high-resolution ultrasound scanner (Acuson 128 Xp/10) equipped with a linear array 3.5-to 5-MHz transducer.…”

Section: Imtmentioning

confidence: 99%

“…The normal range for GHb with our assay is between 3.5 and 6.0%. Blood pressure was recorded at each outpatient visit as the mean of three standard measurements, and the presence of hypertension was determined as described (9). ANP and BNP levels were assayed with an ELISA kit (Peninsula Laboratories) with a minimum detectable dose of 0.04 -0.06 ng/ml.…”

Section: Fiorina and Associatesmentioning

confidence: 99%

“…With diabetic coronary angiopathy, progressive worsening of coronary artery atherosclerosis and macroangiopathy is evident in patients with diabetes, but pancreas and islet transplants reduce this risk (7)(8)(9)(10)(11). A noninvasive marker of atherosclerosis and coronary events is intimamedia thickness (IMT) (12), which is stabilized with pancreas transplantation (9).…”

mentioning

confidence: 99%

“…A noninvasive marker of atherosclerosis and coronary events is intimamedia thickness (IMT) (12), which is stabilized with pancreas transplantation (9).…”

mentioning

confidence: 99%

See 4 more Smart Citations

Islet Transplantation Is Associated With an Improvement of Cardiovascular Function in Type 1 Diabetic Kidney Transplant Patients

¹

,

²

,

³

et al. 2005

Diabetes Care

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OBJECTIVE -Cardiovascular mortality and morbidity are major problems in type 1 diabetic patients with end-stage renal disease (ESRD). The aim of this study was to determine whether islet transplantation can improve cardiovascular function in these patients. RESEARCH DESIGN AND METHODS -We assessed various markers of cardiac function at baseline and 3 years later in a population of 42 type 1 diabetic patients with ESRD who received a kidney transplant. Seventeen patients then received an islet transplant that had persistent function as defined by long-term C-peptide secretion (kidney-islet group). Twentyfive patients did not receive a functioning islet transplant (kidney-only group).RESULTS -GHb levels were similar in the two groups, whereas the exogenous insulin requirement was lower in the kidney-islet group with persistent C-peptide secretion. Overall, cardiovascular parameters improved in the kidney-islet group, but not in the kidney-only group, with an improvement of ejection fraction (from 68.2 Ϯ 3.5% at baseline to 74.9 Ϯ 2.1% at 3 years posttransplantation, P Ͻ 0.05) and peak filling rate in end-diastolic volume (EDV) per second (from 3.87 Ϯ 0.25 to 4.20 Ϯ 0.37 EDV/s, P Ͻ 0.05). Time to peak filling rate remained stable in the kidney-islet group but worsened in the kidney-only group (P Ͻ 0.05). The kidneyislet group also showed a reduction of both QT dispersion (53.5 Ϯ 4.9 to 44.6 Ϯ 2.9 ms, P Ͻ 0.05) and corrected QT (QTc) dispersion (67.3 Ϯ 8.3 to 57.2 Ϯ 4.6 ms, P Ͻ 0.05) with higher erythrocytes Na ϩ -K ϩ -ATPase activity. In the kidney-islet group only, both atrial natriuretic peptide and brain natriuretic peptide levels decreased during the follow-up, with a stabilization of intima-media thickness.CONCLUSIONS -Our study showed that type 1 diabetic ESRD patients receiving a kidney transplant and a functioning islet transplant showed an improvement of cardiovascular function for up to 3 years of follow-up compared with the kidney-only group, who experienced an early failure of the islet graft or did not receive an islet graft. Diabetes Care 28:1358 -1365, 2005M ost cardiac disease and events in type 1 diabetic patients are due to 1) diabetic cardiomyopathy, with progressive deterioration of left ventricular function; 2) diabetic coronary angiopathy, with progression of coronary atherosclerosis; or 3) diabetic sudden death resulting from myocyte electrical failure (1-3).With diabetic cardiomyopathy, systolic dysfunction in normotensive diabetic patients has not been clearly shown (3). Abnormality in diastolic dysfunction has been uniformly observed in asymptomatic diabetic patients, but its relationship with metabolic control in type 1 diabetic patients is still a matter of debate (4 -6).With diabetic coronary angiopathy, progressive worsening of coronary artery atherosclerosis and macroangiopathy is evident in patients with diabetes, but pancreas and islet transplants reduce this risk (7-11). A noninvasive marker of atherosclerosis and coronary events is intimamedia thickness (IMT) (12), which is stabil...

“…The mean of the right and the left longitudinal common carotid artery IMT measurements was used in the analysis. Intraobserver variability was 0.02 Ϯ 0.02 mm in our group as previously reported (9).…”

Section: Fiorina and Associatessupporting

confidence: 72%

“…The operators measuring IMT, as well as people who read all cardiovascular tests, were blinded on patients' conditions (9). Briefly, ultrasonographic analysis of the carotid artery was done with a high-resolution ultrasound scanner (Acuson 128 Xp/10) equipped with a linear array 3.5-to 5-MHz transducer.…”

Section: Imtmentioning

confidence: 99%

“…The normal range for GHb with our assay is between 3.5 and 6.0%. Blood pressure was recorded at each outpatient visit as the mean of three standard measurements, and the presence of hypertension was determined as described (9). ANP and BNP levels were assayed with an ELISA kit (Peninsula Laboratories) with a minimum detectable dose of 0.04 -0.06 ng/ml.…”

Section: Fiorina and Associatesmentioning

confidence: 99%

“…With diabetic coronary angiopathy, progressive worsening of coronary artery atherosclerosis and macroangiopathy is evident in patients with diabetes, but pancreas and islet transplants reduce this risk (7)(8)(9)(10)(11). A noninvasive marker of atherosclerosis and coronary events is intimamedia thickness (IMT) (12), which is stabilized with pancreas transplantation (9).…”

mentioning

confidence: 99%

“…A noninvasive marker of atherosclerosis and coronary events is intimamedia thickness (IMT) (12), which is stabilized with pancreas transplantation (9).…”

mentioning

confidence: 99%

See 3 more Smart Citations

Islet Transplantation Is Associated With an Improvement of Cardiovascular Function in Type 1 Diabetic Kidney Transplant Patients

¹

,

²

,

³

et al. 2005

Diabetes Care

Self Cite

View full text Add to dashboard Cite

OBJECTIVE -Cardiovascular mortality and morbidity are major problems in type 1 diabetic patients with end-stage renal disease (ESRD). The aim of this study was to determine whether islet transplantation can improve cardiovascular function in these patients. RESEARCH DESIGN AND METHODS -We assessed various markers of cardiac function at baseline and 3 years later in a population of 42 type 1 diabetic patients with ESRD who received a kidney transplant. Seventeen patients then received an islet transplant that had persistent function as defined by long-term C-peptide secretion (kidney-islet group). Twentyfive patients did not receive a functioning islet transplant (kidney-only group).RESULTS -GHb levels were similar in the two groups, whereas the exogenous insulin requirement was lower in the kidney-islet group with persistent C-peptide secretion. Overall, cardiovascular parameters improved in the kidney-islet group, but not in the kidney-only group, with an improvement of ejection fraction (from 68.2 Ϯ 3.5% at baseline to 74.9 Ϯ 2.1% at 3 years posttransplantation, P Ͻ 0.05) and peak filling rate in end-diastolic volume (EDV) per second (from 3.87 Ϯ 0.25 to 4.20 Ϯ 0.37 EDV/s, P Ͻ 0.05). Time to peak filling rate remained stable in the kidney-islet group but worsened in the kidney-only group (P Ͻ 0.05). The kidneyislet group also showed a reduction of both QT dispersion (53.5 Ϯ 4.9 to 44.6 Ϯ 2.9 ms, P Ͻ 0.05) and corrected QT (QTc) dispersion (67.3 Ϯ 8.3 to 57.2 Ϯ 4.6 ms, P Ͻ 0.05) with higher erythrocytes Na ϩ -K ϩ -ATPase activity. In the kidney-islet group only, both atrial natriuretic peptide and brain natriuretic peptide levels decreased during the follow-up, with a stabilization of intima-media thickness.CONCLUSIONS -Our study showed that type 1 diabetic ESRD patients receiving a kidney transplant and a functioning islet transplant showed an improvement of cardiovascular function for up to 3 years of follow-up compared with the kidney-only group, who experienced an early failure of the islet graft or did not receive an islet graft. Diabetes Care 28:1358 -1365, 2005M ost cardiac disease and events in type 1 diabetic patients are due to 1) diabetic cardiomyopathy, with progressive deterioration of left ventricular function; 2) diabetic coronary angiopathy, with progression of coronary atherosclerosis; or 3) diabetic sudden death resulting from myocyte electrical failure (1-3).With diabetic cardiomyopathy, systolic dysfunction in normotensive diabetic patients has not been clearly shown (3). Abnormality in diastolic dysfunction has been uniformly observed in asymptomatic diabetic patients, but its relationship with metabolic control in type 1 diabetic patients is still a matter of debate (4 -6).With diabetic coronary angiopathy, progressive worsening of coronary artery atherosclerosis and macroangiopathy is evident in patients with diabetes, but pancreas and islet transplants reduce this risk (7-11). A noninvasive marker of atherosclerosis and coronary events is intimamedia thickness (IMT) (12), which is stabil...

Islet Transplantation

¹

,

²

,

³

et al. 2003

International Textbook of Diabetes Mellitus

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The discovery of insulin dramatically changed the outcome for patients with type 1 diabetes and the acute lethal complications of diabetes like diabetic ketoacidosis could be effectively treated. However, the improved survival allowed the development of the secondary complications of diabetes. Typically the patient with type 1 diabetes develops retinopathy, nephropathy, neuropathy, or vascular disease over time. It was not until 1993 that definitive proof for the value of good glycemic control was established. Controlling glycemia with exogenous insulin remains a challenge. Given the nonphysiological subcutaneous route of insulin administration, its inherent delay in absorption, the variability of serum levels obtained, and the systemic versus portal venous delivery, it is perhaps remarkable how well the glucose levels are actually controlled. Many efforts have been made to generate a closed‐loop system for glucose control, including the Biostator® and insulin infusion pumps. The goal of any closed‐loop system is to have reliable glucose sensing linked to appropriate insulin delivery on a continuous basis. Mechanical closed‐loop systems may in the future achieve this but have been fraught with problems despite early promise. Transplantation of islets of Langerhans or of the whole pancreas can achieve a physiological closed‐loop system today.

Pancreas Transplantation

2003

International Textbook of Diabetes Mellitus

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Pancreas transplantation was first begun for the treatment of type 1 diabetes in humans in 1966. Not many procedures were performed up to 1978 because of the low rates of graft survival. Thereafter, important improvements in immunosuppressive therapy developed, most notably the use of anti‐T‐cell agents and cyclosporine. These new drugs, combined with new surgical techniques and the selection of healthier recipients, led to a much greater use of pancreas transplant for therapeutic intervention. By the year 2000, over 14 000 pancreas transplantations had been performed worldwide. Successful pancreas transplantation restores normal glycemia and glucagon and symptom responses to hypoglycemia as well as stabilizes neuropathy and macrovascular disease. It can also reverse structural damage in kidneys. Quality‐of‐life studies demonstrate excellent acceptance of the procedure by patients.

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