Simultaneous Pancreas Kidney Transplantation Improves Cardiovascular Autonomic Neuropathy with Improved Valsalva Ratio as the Most Precocious Test

Abstract

Background. Simultaneous pancreas-kidney (SPK) transplantation is a proven option of treatment for patients with type 1 diabetes mellitus (T1DM) and related end-stage renal disease. There is discrepancy between the results of different studies about the impact of prolonged normalization of glucose metabolism achieved by SPK on the course of diabetic complications including severe forms of diabetic neuropathy. The objective of the study was to evaluate the prevalence of cardiovascular autonomic neuropathy (CAN) in patients undergoing SPK transplantation and its evolution 10 years after transplantation. Methods. Prospective study of 81 patients transplanted in a single center from year 2002 to 2015. Autonomic function was assessed using cardiovascular autonomic reflex tests (CARTs). CARTs were made before SPK transplantation and during the follow-up. Evolution of tests after SPK transplantation was evaluated by contrasting hypotheses (paired tests). Multiple testing was adjusted with the Benjamini-Hochberg procedure with a false discovery rate of 10%. Results. 48 males and 33 females, mean age 37:4 ± 5:7 years, mean BMI 24:0 ± 3:4 kg/m 2 , and mean duration of diabetes 25:5 ± 6:5 years, received SPK transplantation. Ten years after SPK transplantation, 56 patients re tained the pancreatic graft (42 of them with normofunctioning pancreas and 14 with low doses of insulin therapy). These 42 patients were selected for the autonomic study. Before transplant procedure, all CART results were abnormal. After SPK transplantation, paired test analysis showed an improvement of systolic blood pressure (SBP) response to orthostasis at the 5 th year after SPK (p = 0:03), as well as improvement of the Valsalva ratio at the 3 rd (p < 0:001) and 5 th (p = 0:001) year after SPK. After correcting for the false discovery rate, all the variables of autonomic study reached significance at different time points. Conclusions. Prevalence of CAN in patients who are candidates for SPK transplantation is high and is generally advanced. SPK transplantation improves CAN with improved Valsalva ratio as the most precocious test.

Kuwanon G protects HT22 cells from advanced glycation end product-induced damage

“…The diabetic population are at significant risk of developing neurodegenerative disease. Although both peripheral and central nerves can be influenced, greater focus should be on the prevention of diseases causing brain dysfunction, as cognitive and memory impairment will seriously influence patient quality of life ( 25 , 31 ). The accumulation of AGEs has been demonstrated to contribute to diabetic encephalopathy ( 32 ).…”

“…ACh is a major neurotransmitter in the brain and its deficition leads to cognitive dysfunction. Dysfunction in the production and/or secretion of ACh is the basic variation that contributes to memory loss ( 31 , 51 , 52 ). To evaluate whether KWG could preserve ACh levels in AGE treated HT22 cells, its content was determined by an ELISA kit.…”

Beta cell replacement therapy

“…The rationale for simultaneous pancreas or pancreatic islet transplantation and kidney transplantation, and pancreas or pancreatic islet transplantation in patients with a functioning transplanted kidney is to improve long-term outcomes compared to kidney transplantation alone. The prognosis is improved by a positive effect of long-term normoglycaemia, preventing the development of chronic micro-and macroangiopathic complications [4][5][6][7][8][9][10].…”

“…In case of failed solid-organ pancreas transplantation, pancreatic islet transplantation may be offered and vice versa. Both solid-organ pancreas transplantation and pancreatic islet transplantation were shown to be beneficial in terms of reduced progression of macro-and microvascular complications compared to the conventional treatment [4][5][6][7][8][9][10].…”

Resultados del trasplante de páncreas en pacientes con diabetes mellitus tipo 1 en la Comunidad Valenciana

“…El protocolo empleado en el trasplante de páncreas ya ha sido previamente descrito [142], [169]. Se empleó la misma técnica quirúrgica, el mismo esquema de inmunosupresión y de profilaxis antitrombótica y antiinfecciosa en todos los pacientes.…”