Islet transplantation improves vascular diabetic complications in patients with diabetes who underwent kidney transplantation: a comparison between kidney-pancreas and kidney-alone transplantation1

Abstract

Successful islet transplantation improves survival, atherothrombotic profile, and endothelial morphology in uremic type 1 diabetic kidney transplant patients.

Natural History of Kidney Graft Survival, Hypertrophy, and Vascular Function in End-Stage Renal Disease Type 1 Diabetic Kidney-Transplanted Patients

“…Pancreas and islet transplantations confer adjunctive benefits for kidney graft survival in ESRD type 1 diabetic patients (6,(12)(13)(14). It is possible that restoration of full endocrine function in the pancreas, or at least partial ␤-cell function, could lead to improved NOS expression in the kidney endocrine (14) and thereby ameliorate kidney vascular function.…”

“…Pancreas and islet transplantation can confer insulin independence in type 1 diabetic transplant patients, thus preventing the progression to diabetic nephropathy, improving graft survival, and ameliorating diabetic macro-/microangiopathy (6,(11)(12)(13)(14)(15)(16)(17). It is likely that islet transplant could ameliorate renal function through improved glycometabolic control and restoration of C-peptide secretion (14,18 -23).…”

“…Glomerular hyperfiltration is the first feature of renal involvement and can be observed soon after diabetes onset, accompanied by a loss of renal functional reserve (3). Microalbuminuria appears later, as do morphological changes such as thickening of the glomerular basement membrane and mesangial expansion (4).Nephrosclerosis or glomerulosclerosis of the transplanted kidney in end-stage renal disease (ESRD) type 1 diabetic kidney transplant patients may result from the interaction of diabetes, hypertension, obesity, smoking, and dyslipidemia and from nephrotoxicity of certain immunosuppressive drugs (calcineurin inhibitors but not only) (5-6), leading to a reduction in the intrarenal vascular surface area and an increase in vascular resistance (7-10).Pancreas and islet transplantation can confer insulin independence in type 1 diabetic transplant patients, thus preventing the progression to diabetic nephropathy, improving graft survival, and ameliorating diabetic macro-/microangiopathy (6,(11)(12)(13)(14)(15)(16)(17). It is likely that islet transplant could ameliorate renal function through improved glycometabolic control and restoration of C-peptide secretion (14,18 -23).…”

Bone Marrow-Derived Stem Cell Transplantation for the Treatment of Insulin-Dependent Diabetes

“…Also, a positive impact of islet transplantation on the progression of diabetes complications has been reported. Although, most of the studies showing reduced complications were small-scale and nonrandomized [9][10][11][12][13][14][15][16].…”

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

“…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).…”