Abstract. The potential effects of islet transplantation on the renal function of 36 patients with type I diabetes mellitus and kidney transplants were studied with 4 yr of follow-up monitoring. Kidney-islet recipients were divided into two groups, i.e., patients with successful islet transplants (SI-K group) (n ϭ 24, fasting C-peptide levels of Ͼ0.5 ng/ml for Ͼ1 yr) and patients with unsuccessful islet transplants (UI-K group) (n ϭ 12, fasting Cpeptide levels of Ͻ0.5 ng/ml). Kidney graft survival rates and function, urinary albumin excretion rates, and sodium handling were compared. Na

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

OBJECTIVE -Cardiovascular mortality and morbidity are major problems in type 1 diabetic patients with end-stage renal disease (ESRD). The aim of this study was to determine whether islet transplantation can improve cardiovascular function in these patients. RESEARCH DESIGN AND METHODS -We assessed various markers of cardiac function at baseline and 3 years later in a population of 42 type 1 diabetic patients with ESRD who received a kidney transplant. Seventeen patients then received an islet transplant that had persistent function as defined by long-term C-peptide secretion (kidney-islet group). Twentyfive patients did not receive a functioning islet transplant (kidney-only group).RESULTS -GHb levels were similar in the two groups, whereas the exogenous insulin requirement was lower in the kidney-islet group with persistent C-peptide secretion. Overall, cardiovascular parameters improved in the kidney-islet group, but not in the kidney-only group, with an improvement of ejection fraction (from 68.2 Ϯ 3.5% at baseline to 74.9 Ϯ 2.1% at 3 years posttransplantation, P Ͻ 0.05) and peak filling rate in end-diastolic volume (EDV) per second (from 3.87 Ϯ 0.25 to 4.20 Ϯ 0.37 EDV/s, P Ͻ 0.05). Time to peak filling rate remained stable in the kidney-islet group but worsened in the kidney-only group (P Ͻ 0.05). The kidneyislet group also showed a reduction of both QT dispersion (53.5 Ϯ 4.9 to 44.6 Ϯ 2.9 ms, P Ͻ 0.05) and corrected QT (QTc) dispersion (67.3 Ϯ 8.3 to 57.2 Ϯ 4.6 ms, P Ͻ 0.05) with higher erythrocytes Na ϩ -K ϩ -ATPase activity. In the kidney-islet group only, both atrial natriuretic peptide and brain natriuretic peptide levels decreased during the follow-up, with a stabilization of intima-media thickness.CONCLUSIONS -Our study showed that type 1 diabetic ESRD patients receiving a kidney transplant and a functioning islet transplant showed an improvement of cardiovascular function for up to 3 years of follow-up compared with the kidney-only group, who experienced an early failure of the islet graft or did not receive an islet graft. Diabetes Care 28:1358 -1365, 2005M ost cardiac disease and events in type 1 diabetic patients are due to 1) diabetic cardiomyopathy, with progressive deterioration of left ventricular function; 2) diabetic coronary angiopathy, with progression of coronary atherosclerosis; or 3) diabetic sudden death resulting from myocyte electrical failure (1-3).With diabetic cardiomyopathy, systolic dysfunction in normotensive diabetic patients has not been clearly shown (3). Abnormality in diastolic dysfunction has been uniformly observed in asymptomatic diabetic patients, but its relationship with metabolic control in type 1 diabetic patients is still a matter of debate (4 -6).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 (7-11). A noninvasive marker of atherosclerosis and coronary events is intimamedia thickness (IMT) (12), which is stabil...