Assessment of Renal Function in Type I Diabetic Patients After Kidney, Pancreas, or Combined Kidney-Pancreas Transplantation

Morel, Philippe; Sutherland, David E.R.; Almond, P. S.; Stöblen, F.; Matas, Arthur J.; Najarían, John S.; Dünn, David L.

doi:10.1097/00007890-199106000-00008

Cited by 29 publications

(10 citation statements)

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“…Studies of diabetic nephropathy focused on disease recurrence or prevention in the kidney grafts of diabetic KTA, SPK, or PAK recipients, 118,168,169 as well as on disease progression, stabilization, or regression of disease in the native kidneys of PTA recipients. 131 Mauer et al documented the recurrence of diabetic nephropathy (vascular lesions 170 and an increase in glomerular and tubular basement membrane and mesangial matrix 168 ) in nearly half of kidneys transplanted without a pancreas in uremic diabetic recipients.…”

Section: Nephropathymentioning

confidence: 99%

“…173 Follow-up biopsies in some have shown cyclosporine-induced lesions that were associated with a progressive decline in kidney function, independent of the diabetic lesions already present. 128,169,174 The diabetic kidney lesions were distinct. In eight PTA recipients who were nonuremic at the time of the pancreas transplant but who had mild to moderately advanced lesions of diabetic nephropathy at baseline, 10-year follow-up biopsies showed that glomerular and tubular basement membrane thickness and mesangial fractional volume of the glomerulus had decreased and, indeed, returned to normal.…”

Section: Nephropathymentioning

confidence: 99%

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Lessons Learned From More Than 1,000 Pancreas Transplants at a Single Institution

Sutherland¹,

Gruessner²,

Dünn³

et al. 2001

Annals of Surgery

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612

434

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ObjectiveTo determine outcome in diabetic pancreas transplant recipients according to risk factors and the surgical techniques and immunosuppressive protocols that evolved during a 33-year period at a single institution. Summary Background DataInsulin-dependent diabetes mellitus is associated with a high incidence of management problems and secondary complications. Clinical pancreas transplantation began at the University of Minnesota in 1966, initially with a high failure rate, but outcome improved in parallel with other organ transplants. The authors retrospectively analyzed the factors associated with the increased success rate of pancreas transplants. MethodsFrom December 16, 1966, to March 31, 2000, the authors performed 1,194 pancreas transplants (111 from living donors; 191 retransplants): 498 simultaneous pancreas-kidney (SPK) and 1 simultaneous pancreas-liver transplant; 404 pancreas after kidney (PAK) transplants; and 291 pancreas transplants alone (PTA). The analyses were divided into five eras: era 0, 1966 to 1973 (n ϭ 14), historical; era 1, 1978 to 1986 (n ϭ 148), transition to cyclosporine for immunosuppression, multiple duct management techniques, and only solitary (PAK and PTA) transplants; era 2, 1986 to 1994 (n ϭ 461), all categories (SPK, PAK, and PTA), predominately bladder drainage for graft duct management, and primarily triple therapy (cyclosporine, azathioprine, and prednisone) for maintenance immunosuppression; era 3, 1994 to 1998 (n ϭ 286), tacrolimus and mycophenolate mofetil used; and era 4, 1998 to 2000 (n ϭ 275), use of daclizumab for induction immunosuppression, primarily enteric drainage for SPK transplants, pretransplant immunosuppression in candidates awaiting PTA. ResultsPatient and primary cadaver pancreas graft functional (insulinindependence) survival rates at 1 year by category and era were as follows: SPK, era 2 (n ϭ 214) versus eras 3 and 4 combined (n ϭ 212), 85% and 64% versus 92% and 79%, respectively; PAK, era 1 (n ϭ 36) versus 2 (n ϭ 61) versus 3 (n ϭ 84) versus 4 (n ϭ 92), 86% and 17%, 98% and 59%, 98% and 76%, and 98% and 81%, respectively; in PTA, era 1 (n ϭ 36) versus 2 (n ϭ 72) versus 3 (n ϭ 30) versus 4 (n ϭ 40), 77% and 31%, 99% and 50%, 90% and 67%, and 100% and 88%, respectively. In eras 3 and 4 combined for primary cadaver SPK transplants, pancreas graft survival rates were significantly higher with bladder drainage (n ϭ 136) than enteric drainage (n ϭ 70), 82% versus 74% at 1 year (P ϭ .03). Increasing recipient age had an adverse effect on outcome only in SPK recipients. Vascular disease was common (in eras 3 and 4, 27% of SPK recipients had a pretransplant myocardial infarction and 40% had a coronary artery bypass); those with no vascular disease had significantly higher patient and graft survival rates in the SPK and PAK categories. Living donor segmental pancreas transplants were associated with higher technically successful graft survival rates in each era, predominately solitary (PAK and PTA) in eras 1 and 2 and SPK in eras 3 and 4. Diabetic seconda...

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Section: Nephropathymentioning

confidence: 99%

Section: Nephropathymentioning

confidence: 99%

Lessons Learned From More Than 1,000 Pancreas Transplants at a Single Institution

Sutherland¹,

Gruessner²,

Dünn³

et al. 2001

Annals of Surgery

Self Cite

612

434

View full text Add to dashboard Cite

show abstract

“…It must also be appreciated that renal function after a pancreas transplant can deteriorate three times more rapidly than diabetic patients with overt nephropathy treated with insulin injections. This is because of the nephrotoxic nature of cyclosporin20 but more recently this has perhaps been curtailed by the use of tacrolimus.…”

Section: Effect Of Pancreas Transplantation On Diabetic Complicationsmentioning

confidence: 99%

Surgical treatment of diabetes mellitus by islet cell and pancreas transplantation

White

Kimber

Veitch

et al. 2001

Postgraduate Medical Journal

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“…This decline is not progressive (82). For these reasons, surgeons at the University of Minnesota, the most experienced pancreas transplant center, recommend that transplantation of human pancreas be regarded as an investigational technique, to be undertaken only by institutions committed to protocol studies with formal long-term follow-up (63).…”

Section: Continuous Ambulatory Peritoneal Dialysis -Cmentioning

confidence: 99%

Diabetic Nephropathy: Management of the end-stage patient

Markell

Friedman

1992

Diabetes Care

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Diabetic nephropathy is currently the leading cause of new patients requiring dialysis in the United States. Management of the diabetic patient with ESRD is complicated by the frequent coexistence of complications affecting other organ systems, including retinopathy, cardiovascular disease, peripheral neuropathy, or autonomic neuropathy, manifested as gastroparesis, diarrhea or obstipation, cystopathy, or orthostatic hypotension. Associated clinical syndromes must be followed and treated, if possible, while preparing the patient to receive renal replacement therapy. Both the clinical condition and the psychosocial environment are key factors in choice of ESRD therapy for an individual patient. Rehabilitation data are best for patients who undergo kidney transplantation, but these data are confounded by the fact that the healthiest patients are referred for this treatment modality. Living, related kidney transplant is the preferred initial choice for the diabetic patient with kidney disease. At most centers, both in the United States and abroad, the cadaveric transplant is the second choice for uremia therapy. At the appropriate institution, the patient with type I diabetes may also be considered for a simultaneous cadaveric pancreas transplant. While awaiting cadaveric transplantation, or if contraindication to transplantation is present (chronic infection, recent malignancy, or severe cardiac disease), diabetic patients with severe impairment of the glomerular filtration rate (less than 10-15 ml/min) are referred for vascular access placement and/or insertion of a peritoneal catheter. The decision regarding the choice of CAPD vs. hemodialysis must be made on an individual basis. Rehabilitation and survival data for these therapies are similar, although technique survival rates for CAPD decline dramatically as time progresses because of infectious complications. In-center hemodialysis has the worst survival and rehabilitation profile, but the sickest, most debilitated patients with the highest number of comorbid conditions tend to be referred for that therapeutic modality. Most studies of rehabilitation were performed before use of recombinant human erythropoietin, and comparison between ESRD treatment modalities will have to be reevaluated now that the drug is routinely used.

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Assessment of Renal Function in Type I Diabetic Patients After Kidney, Pancreas, or Combined Kidney-Pancreas Transplantation

Cited by 29 publications

References 0 publications

Lessons Learned From More Than 1,000 Pancreas Transplants at a Single Institution

Lessons Learned From More Than 1,000 Pancreas Transplants at a Single Institution

Surgical treatment of diabetes mellitus by islet cell and pancreas transplantation

Diabetic Nephropathy: Management of the end-stage patient

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