The Beneficial Effects of Pancreas Transplant Alone on Diabetic Nephropathy

Abstract

OBJECTIVE -Pancreas transplant alone can be effective in significantly improving the quality of life of type 1 diabetic patients, and it can also eliminate acute diabetes complications, such as hypoglycemic and/or hyperglycemic episodes. The effects of pancreas transplant alone on long-term complications of diabetes, including nephropathy, are still not settled. We evaluated whether restoration of long-lasting normoglycemia by pancreas transplant alone might have beneficial action on diabetic nephropathy. RESEARCH DESIGN AND METHODS-A total of 32 type 1 diabetic patients were evaluated before and 1 year after successful pancreas transplant alone, together with 30 matched nontransplanted type 1 diabetic subjects. Several metabolic and kidney function parameters were measured, including plasma glucose, glycohemoglobin (A1C), C-peptide, plasma lipids, blood pressure, creatinine, creatinine clearance, and urinary protein excretion.RESULTS -Pancreas transplant alone restored sustained normoglycemia, without exogenous insulin administration, and improved plasma lipid levels. Blood pressure decreased significantly. Creatinine concentrations and clearances did not differ before and after transplantation. Urinary protein excretion decreased significantly after pancreas transplant alone, with four microalbuminuric and three macroalbuminuric patients who became normoalbuminuric. None of these changes occurred in the nontransplanted group.CONCLUSIONS -Successful pancreas transplant alone, through restoration of sustained normoglycemia, improves diabetic nephropathy in type 1 diabetic patients. Diabetes Care 28:1366 -1370, 2005D iabetic nephropathy is the most common single cause of end-stage renal disease in the U.S. and Europe (1). In the U.S., this late diabetes complication accounts for ϳ40% of new cases of end-stage renal disease, with costs that exceed $15 billion per year (1). Epidemiological data show that ϳ20 -30% of patients with diabetes develop nephropathy (1-4). The earliest clinical sign of nephropathy is the appearance of low but abnormal levels (Ͼ30 mg/day or 20 g/ min) of albumin in the urine, referred to as microalbuminuria. Without specific interventions, 80% of subjects with type 1 diabetes who develop sustained microalbuminuria have their urinary albumin excretion increase at a rate of 10 -20% per year to the stage of overt nephropathy or clinical albuminuria (up to 300 mg/24 h or 200 g/min) over a period of 10 -15 years, with hypertension also developing along the way. Once overt nephropathy occurs, without specific treatment the glomerular filtration rate gradually falls over a period of several years at a rate that is highly variable from individual to individual (2-20 ml ⅐ min Ϫ1 ⅐ year Ϫ1 ). Eventually, end-stage renal disease develops in 50% of type 1 diabetic individuals with overt nephropathy within 10 years and in Ͼ75% by 20 years. In addition to its being the earliest manifestation of nephropathy, proteinuria is a marker of greatly increased cardiovascular morbidity and mortality for patients w...

Pancreas transplant alone has beneficial effects on retinopathy in type 1 diabetic patients

“…Restoration of endogenous insulin secretion and normalisation of glucose concentrations could also have affected the improvement of lipid and blood pressure levels, although the mechanisms are still unclear [26,27]. Notably, ACE-inhibition and statin therapies, which can favourably influence the course of microangiopathy [28][29][30], were not substantially different before and after PTA in our patients.…”

Results of Pancreas Transplantation Alone with Special Attention to Native Kidney Function and Proteinuria in Type 1 Diabetes Patients

“…Regarding the question why proteinuria declined after PTA, it is possible that normalization of blood glucose and restored C-peptide secretion may play a role, as previously discussed [15]. Reduction in glucose levels is associated with decreased hyperfiltration and diminished albuminuria [30,31].…”

“…Renal function, proteinuria, retinopathy, and neuropathy were evaluated, as detailed previously [14,15,[20][21][22].…”

Trasplante simultáneo de páncreas y riñon en diabetes mellitus tipo 1: Experiencia de un centro en Chile

“…En nuestro medio no se han efectuado dos técnicas alternativas al TSPR: trasplante de páncreas en receptor ya trasplantado de riñón y trasplante aislado de páncreas en sujetos con función renal mayor de 50 ml/min 19,20 . La primera opción requiere un programa de procuramiento de páncreas desarrollado y expedito, mientras la segunda opción se aplica selectivamente a DM 1 muy inestable y las consideraciones de los riesgos de la inmunosupresión han prevalecido por sobre las ventajas de la euglicemia.…”