Peripheral Vascular Disease After Kidney-Pancreas Transplantation in Diabetic Patients With End-stage Renal Disease

Morrissey, Paul; Shaffer, David R.; Monaco, Anthony P.; Conway, Patricia; Madras, Peter N.

doi:10.1001/archsurg.1997.01430280032004

Cited by 61 publications

(32 citation statements)

References 17 publications

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“…[55][56][57] Moreover, renal transplant recipients frequently have severe and progressive peripheral arterial disease, which is not ameliorated by concomitant pancreas transplantation, despite improved glycemic control. [56,58] The causal pathways of the diabetic foot in renal failure are multiple and inter-related. A case has been made both for neuropathy [41] and peripheral arterial disease.…”

Section: The Diabetic Foot In Esrdmentioning

confidence: 99%

“…A case has been made both for neuropathy [41] and peripheral arterial disease. [43,56,58] Yet foot lesions are, rather, attributable to a combination of both entities. [39,59,60] Certainly, diabetic nephropathy, especially ESRD, is accompanied by an increased prevalence of peripheral arterial disease, [5,6,60] largely associated with longer diabetes duration [5,6,59] but also with a significantly more frequent presence of vascular risk factors.…”

Section: The Diabetic Foot In Esrdmentioning

confidence: 99%

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The Diabetic Foot in End Stage Renal Disease

et al. 2007

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Diabetic foot lesions remain a major cause of morbidity in patients with renal failure, especially those on dialysis. Foot complications are encountered at a more than twofold frequency in diabetic patients with end-stage renal disease, and the rate of amputations is 6.5-10 times higher in comparison to the general diabetic population. The causal pathways of the diabetic foot in renal failure are multiple and inter-related. Three major pathologies-neuropathy, ischemia, and infection-are the main contributory factors. Increased awareness of this condition and careful clinical examination are indispensable to avoid serious complications. Appropriate management needs to address all contributory factors. Treatment options include revascularization, off-loading to relieve high-pressure areas, and aggressive control of infection. Equally important is the collaboration between health care providers in a multidisciplinary foot care setting. Moreover, patient education on the measures required to achieve both primary and secondary prevention is of great value. Certainly, technical innovations have made considerable progress possible, but there is a need for further improvement to reduce the number of amputations.

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Section: The Diabetic Foot In Esrdmentioning

confidence: 99%

Section: The Diabetic Foot In Esrdmentioning

confidence: 99%

The Diabetic Foot in End Stage Renal Disease

et al. 2007

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“…The results of these studies [5,6] were controversial; the incidence of peripheral vascular complications in recipients of SPKT was either similar or higher in comparison with patients with KTA. In a recent study a substantial reduction in mortality in Type I diabetic patients 10 years after successful SPKT was, however, found [7].…”

Section: Discussionmentioning

confidence: 99%

“…One study compared the progression of peripheral vascular disease of pancreas-kidney recipients with that of patients who received a kidney transplant alone (KTA) [5]. Despite insulin independence, pancreas-kidney recipients had a statistically significantly higher incidence of peripheral vascular complications.…”

Section: : 231±234]mentioning

confidence: 99%

Comparison of progression of macrovascular diseases after kidney or pancreas and kidney transplantation in diabetic patients with end-stage renal disease

et al. 2000

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Simultaneous pancreas-kidney transplantation (SPKT) has become the therapy of choice in patients with Type I (insulin-dependent) diabetes mellitus who have end-stage renal disease. During the last decade graft and patient survival have been improved, the 1-year pancreas graft survival rate is currently at 81 % for SPKT [1].Several studies have shown that diabetic retinopathy and peripheral neuropathy are positively influenced by pancreas transplantation [2,3]. A recent study also showed that pancreas transplantation in non-uraemic patients can reverse lesions of diabetic nephropathy, but this is not seen before 5 years of normoglycaemia [4]. Diabetologia (2000) Abstract Aims/hypothesis. The aim of the study was to examine the effect of pancreas-kidney transplantation on the progression of macrovascular diseases in Type I diabetic patients with end-stage renal disease.Methods. The progression of cerebrovascular disease, coronary heart disease and peripheral vascular disease in uraemic patients with Type I (insulin-dependent) diabetes mellitus and who had had simultaneous pancreas-kidney transplantation was compared with that of recipients of a kidney transplant alone. Between 1986 and 1998 a total of 11 uraemic diabetic patients received a simultaneous pancreaskidney transplantation and 10 diabetic patients a kidney transplant alone. All transplants functioned for at least 24 months, the mean observation period was 69 ± 37 compared with 70 ± 33 months in both patient groups. Macroangiopathic diseases were classified in four stages as described earlier.Results. In the group with simultaneous pancreas-kidney transplantation progression of cerebrovascular and coronary heart disease was observed in four patients (36 %) and progression of peripheral vascular disease in five subjects (45 %). In the cohort with kidney transplant alone four patients (40 %) showed progression of cerebrovascular and coronary heart disease and five progression of peripheral vascular disease (50 %); the difference is not significant. Mean values of HbA 1 c (5.8 ± 0.2 vs 7.5 ± 0.6 %, p < 0.001) and serum triglycerides (1.2 ± 0.4 vs 2.0 ± 1.0 mmol/l, p < 0.05) were significantly lower in the patients with pancreas-kidney transplantation than in the patient group with kidney transplant alone. Serum cholesterol concentrations and blood pressures were similar in both cohorts. Conclusion/interpretation. From our results we concluded that pancreas-kidney transplantation reduces risk factors for the development of macroangiopathy but fails to halt progression of macrovascular diseases similar to Type I diabetic patients with kidney transplant alone. [Diabetologia (2000) 43: 231±234]

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“…Pancreas transplantation has been associated with some improvements in diabetic neuropathy (941)(942)(943)(944), but the fact that neuropathy may also improve after kidney transplantation alone makes it difficult to quantitate improvements due to pancreas transplantation without controlled trials (945). No benefits in macrovascular complications have been demonstrated when comparing recipients of combined kidney-pancreas transplants and kidney transplants alone (946,947).…”

Section: Endocrinementioning

confidence: 99%

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

2001

American Journal of Transplantation

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Peripheral Vascular Disease After Kidney-Pancreas Transplantation in Diabetic Patients With End-stage Renal Disease

Cited by 61 publications

References 17 publications

The Diabetic Foot in End Stage Renal Disease

The Diabetic Foot in End Stage Renal Disease

Comparison of progression of macrovascular diseases after kidney or pancreas and kidney transplantation in diabetic patients with end-stage renal disease

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

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