Late Diabetic Complications in Patients with Type 1 Diabetes who Received Simultaneous Pancreas-Kidney Transplantation

Глазунова, А М; Михайловна, Глазунова Александра; Arutyunova, Margarita; Станиславовна, Арутюнова Маргарита; Tarasov, Evgeny Vladimirovich; Владимирович, Тарасов Евгений; Shamhalova, Minara; Шамхаловна, Шамхалова Минара; Shestakova, Marina Vladimirovna; Владимировна, Шестакова Марина; Moysyuk, Ya. G.; Геннадьевич, Мойсюк Ян; Пинчук, А. В.; Валерьевич, Пинчук Алексей; Дмитриев, И. В.; Викторович, Дмитриев Илья; Арзуманов, С. В.; Викторович, Арзуманов Сергей

doi:10.14341/dm2015269-78

Cited by 4 publications

(1 citation statement)

References 25 publications

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“…Во множестве исследований продемонстрировано, что СТПиПЖ существенно улучшает качество жизни и выживаемость пациентов за счет нормализации показателей углеводного обмена, несмотря на более сложное течение самого оперативного вмешательства и послеоперационный риск [2]. Ведущее значение в долговременном прогнозе имеет благоприятное влияние нормогликемии в отношении сердечно-сосудистых состояний -основной причины смертности пациентов с СД [3,4]. В отношении ДН было показано, по меньшей мере, замедление прогрессирования осложнения и лучшая выживаемость трансплантированной почки при сравнении с пациентами, перенесшими изолированную трансплантацию почки [4,5].…”

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Сhronic kidney disease complications in patients with type 1 diabetes mellitus after simultaneous pancreas-kidney transplantation – potential role of oxidative stress and glycation end products

Larina¹,

Severina²,

Шамхалова³

et al. 2020

Diabetes mellitus

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BACKGROUND: Normoglycaemia in patients with diabetes mellitus type 1 (T1DM) after simultaneous pancreas-kidney transplantation (SPKT) is very interesting in regards to chronic kidney disease (CKD) complications dynamics depending of posttransplantation period and possible targets of potential treatment from the point of view metabolic memory AIM: To evaluate the relationship between oxidative stress indicators and advanced glycation end products and complications of end-stage renal disease (ESRD) in patients with T1DM аnd a long-term history of diabetes decompensation, who reached stable euglycemia after SPKT. MATERIALS AND METHODS: The study included 20 patients with compensation of carbohydrate metabolism after SPKT performed from November 2011 to September 2018. Assessment included examination of complications of ESRD (arterial hypertension, dyslipidemia, anemia, mineral and bone disorder) and analysis of "metabolic memory" markers: 3-nitrothyrosine (3-NT), superoxide dismutase (SOD), advanced glycation end products (AGE) and AGE receptor (RAGE). We performed follow-up examination of patients included in the early postoperative period (1st day/week) in 6-12 months after SPKT. RESULTS: All patients with DM1 duration for 22 [19; 28] years, diabetic nephropathy (DN) 8 [6; 14] years and duration of renal replacement therapy (dialysis) for 3 [1.5; 4] years reached euglycemia (HbA1c 5,5 [5,1; 5,8] %; С-peptide 3,2 [2,45; 3,63] ng/ml) after 6 month of surgical treatment. Despite of stable graft function (estimated glomerular filtration rate (eGFR) CKD-EPI 84 [69; 95] ml/min/1.73m2) 35% of patients still needed antihypertensive therapy, 40% needed treatment with recombinant human erythropoietin (RHuEPO) and 15% ferrotherapy. With vitamin D deficiency, observed in 80% of cases (13.3 [9.3; 18.5] ng/ml), 55% of patients had secondary hyperparathyroidism, 45% osteoporosis. The results of the correlation analysis revealed the association of the state of ESRD target organs with the studied "metabolic memory" markers: oxidative stress and AGE-RAGE system. CONCLUSIONS: SPKT as the way to achieve compensation of carbohydrate metabolism and uremia does not provide regress of diabetes and complications of ESRD. Analysis of "metabolic memory" markers indicate their direct contribution to the persistence of metabolic consequences of diabetic nephropathy (DN). Found trends need more long-lasting observation and enlargement of study groups.

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Сhronic kidney disease complications in patients with type 1 diabetes mellitus after simultaneous pancreas-kidney transplantation – potential role of oxidative stress and glycation end products

Larina¹,

Severina²,

Шамхалова³

et al. 2020

Diabetes mellitus

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Specific features of anesthetic management in simultaneous pancreas and kidney transplantation in a recipient with morbid obesity

Lebedev,

Kuznetsova,

Talyzin

et al. 2024

Transplantologiâ (Mosk.)

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Introduction. Anesthetic management in simultaneous pancreas and kidney transplantation in recipients has some specific features. In addition to the presence of underlying pathology in the form of type 1 diabetes mellitus and secondary diabetic complications, pronounced comorbidities can often make some difficulties for an anesthesiologist.Aim. We have reported a clinical case showing the specific features of anesthetic support for simultaneous pancreas and kidney transplantation in a recipient with morbid obesity.Clinical Case Report. Specific features of the anesthetic management of a 42-year-old patient L. with morbid obesity (body mass index 43.3 kg/m2) and hypertension who underwent simultaneous pancreas and kidney transplantation have been described. A preoperative examination of this patient revealed predictors of difficult airways, so endoscopically assisted intubation was performed. The Trendelenburg position of the patient during surgical intervention due to an excess body weight led to the increased intrathoracic pressure intraoperatively. The pressure ventilation mode, the neutral position of the patient on the operating table, and the monitoring of ventilation efficiency made it possible to return the elevated intrathoracic pressure to normal. A preoperative examination by a cardiologist, timely diagnosis and treatment of hypertension at the stage of placing the patient on the waiting list made it possible to exclude adverse hemodynamic reactions at the main stages of the operation. The patient was extubated on surgery completion in the Operating Room. The pancreatic graft function and the kidney graft function were satisfactory.Conclusion. Our approaches ensured the safety and efficacy of anesthesiological support and contributed to the successful implementation of simultaneous pancreas and kidney transplantation in the recipient having the concomitant pathology in the form of morbid obesity.

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Hemoperfusion and functional state of the macula after simultaneous pancreas and kidney transplantation

Vorobyeva

Bulava

et al. 2022

BRSMU

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Simultaneous pancreas and kidney transplantation (SPK) provides effective treatment in patients with type 1 diabetes mellitus (T1DM) and end-stage renal failure (ESRF), mitigating the hyperglycemia and uremic syndrome. The study aimed at the assessment of morphofunctional status of the macula and macular hemodynamics in patients with T1DM after SPK. The study enrolled 45 patients subdivided into three groups: Group A — patients with T1DM after SPK; Group B — patients with T1DM and ESRF, maintained on programmed hemodialysis (PH), on waiting list for SPK; and Group C — individuals without ophthalmic or systemic pathologies. All patients were subject to the standard ophthalmological examination complemented by measurements of the central retinal thickness (CRT) and the average perfusion density (PD) in four vascular layers: superficial capillary plexus of the retina (SCP), deep capillary plexus of the retina (DCP), choriocapillaris, and choroid. The patients after SPK had significantly lower CRT (241 ± 33 µm in Group A, 309±10 µm in Group B; p < 0.05) and significantly higher PD of the macular region in both the retina (Group A: SCP — 19.0 ± 1.6%, DCP — 10.7 ± 1.3%; Group B: SCP — 11.7 ± 0.8%, DCP — 4.8 ± 0.8%; p < 0.05) and the choroid (Group A: choriocapillaris — 28.1 ± 1.8%, choroid — 31.3 ± 1.6%; Group B: choriocapillaris — 20.4 ± 1.6%, choroid — 21.8 ± 1.3%; p < 0.05), as well as significantly higher visual acuity (Group A: 0.7 ± 0.1; Group B: 0.5 ± 0.1; p < 0.05) and macular light threshold (Group A: 25.9 ± 1.4 dB; Group B: 22.3 ± 1.1 dB; p < 0.05) compared with the patients on PH. Thus, the normalization of carbohydrate metabolism and the mitigation of uremic syndrome in patients with T1DM and ESRF after SPK favorably affect the functional condition of the macular area, as indicated by the improvement in macular blood flow and visual functions.

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Late Diabetic Complications in Patients with Type 1 Diabetes who Received Simultaneous Pancreas-Kidney Transplantation

Cited by 4 publications

References 25 publications

Сhronic kidney disease complications in patients with type 1 diabetes mellitus after simultaneous pancreas-kidney transplantation – potential role of oxidative stress and glycation end products

Сhronic kidney disease complications in patients with type 1 diabetes mellitus after simultaneous pancreas-kidney transplantation – potential role of oxidative stress and glycation end products

Specific features of anesthetic management in simultaneous pancreas and kidney transplantation in a recipient with morbid obesity

Hemoperfusion and functional state of the macula after simultaneous pancreas and kidney transplantation

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