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

Biesenbach, Georg; Margreiter, Raimund; Königsrainer, Alfred; Bösmüller, Claudia; Janko, O; Brücke, P; Gross, Christoph; Zazgórnik, J

doi:10.1007/s001250050034

Cited by 36 publications

(17 citation statements)

References 11 publications

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“…There are very few studies that have actually assessed cardiovascular outcomes comparing SPK with KTA. In a small study, Biesenbach et al [32] showed a reduction in risk factors for the development of macroangiopathy but failure to halt progression of macrovascular diseases (CAD, CBVD and PAD) in 11 SPK recipients compared with ten KTA (kidneys from deceased donors) recipients with at least 2 year functioning grafts and a follow-up time of nearly 6 years. However, later on and with a longer follow-up time, the same group showed that the progression of macrovascular diseases was significantly lower in recipients with a functioning SPK graft compared with KTA recipients [33].…”

Section: Discussionmentioning

confidence: 99%

Long-term cardiovascular outcomes in type 1 diabetic patients after simultaneous pancreas and kidney transplantation compared with living donor kidney transplantation

et al. 2015

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Aims/hypothesis Mortality due to cardiovascular disease (CVD), particularly coronary artery disease (CAD), is high in type 1 diabetic patients with end-stage renal disease (ESRD). We aimed to determine whether normoglycaemia, as achieved by successful simultaneous pancreas and kidney (SPK) transplantation, could improve long-term outcomes compared with living donor kidney-alone (LDK) transplantation. Methods We studied 486 type 1 diabetic patients with ESRD who underwent a first SPK (n = 256) or LDK (n = 230) transplant between 1983 and 2012 and were followed to the end of 2014. Data were retrieved from the Norwegian Renal Registry and hospital records. Kaplan-Meier plots and multivariate Cox regression, with correction for recipient, donor and transplant factors, were used to examine potential associations between transplant type and all-cause and CVD-and CADrelated mortality. Results Median follow-up time was 7.9 years (interquartile range 4.3, 12.9). The adjusted HR for CVD-related deaths in SPK recipients compared with LDK recipients was 0.63 (95% CI 0.40, 0.99; p = 0.047), while the HRs for all-cause and CAD-related mortality were 0.81 (95% CI 0.57, 1.16; p = 0.25) and 0.63 (95% CI 0.36, 1.12; p = 0.12), respectively. Compared with the LDK group, SPK recipients were younger and received grafts from younger donors. Cardiovascular mortality was higher in patients transplanted between 1983 and 1999 compared with those who received their grafts in subsequent years. Conclusions/interpretation In patients with type 1 diabetes and ESRD, SPK transplantation was associated with reduced long-term cardiovascular mortality compared with LDK transplantation.

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Section: Discussionmentioning

confidence: 99%

Long-term cardiovascular outcomes in type 1 diabetic patients after simultaneous pancreas and kidney transplantation compared with living donor kidney transplantation

et al. 2015

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“…In an investigation of carotid intimal thickness in pancreas transplantation candidates and in pancreas transplant recipients 4‐yr post‐transplant, the latter group had lower thickness, suggesting a beneficial effect of the procedure, when successful (18). In a small Austrian series, the extent of cardiovascular disease was classified in SPK and kidney‐alone transplant recipients at baseline and for a follow‐up time of 5 yr on average (16). No difference in the progression of macrovascular manifestations was seen.…”

Section: Discussionmentioning

confidence: 99%

Macrovascular disease after simultaneous pancreas and kidney transplantation

Nordén

Carlström

Wramner

et al. 2004

Clinical Transplantation

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The objective of this study was to evaluate the outcome of simultaneous pancreas and kidney transplantation (SPK) with focus on cardiovascular mortality and morbidity in relation to graft function. From January 1985 through 1999, 87 SPK were performed in the unit. Sixty recipients were males, median age at diabetes onset 13 yr (1-40) and age at transplantation 39 yr (29-54). No case was lost to follow-up. Morbidity and mortality during median 8 yr of follow-up (range 1-15 yr) were recorded. Major macrovascular disease (MVD) was defined as myocardial infarction or sudden death (AMI), stroke or peripheral gangrene requiring amputation of leg, foot or fingers. At the evaluation, 26 of 87 patients (30%) had died, 19 after loss of the pancreas graft and 20 after loss of the kidney. MVD was the dominant cause of death. Non-lethal MVD had previously been recorded in 62%. Of the 61 patients alive, 22 had lost their pancreas graft and 12 the concomitant kidney. MVD had occurred in 32%. Whereas 89% of the concomitant kidneys functioned when the pancreas graft did so, only 37% of the kidneys functioned if the pancreas had been lost, p < 0.0001. The mortality rate was significantly higher among patients who lost both grafts (16/26) than in those who lost only the pancreas graft (3/15), p = 0.01. Progressive MVD is a major clinical problem for SPK transplant patients, particularly if the kidney fails.

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“…In our study we compared the progression of vascular diseases in type 1 diabetic patients with KTA and SPKT over a mean period of 10 years. In an earlier study with patients with at least 2‐year functioning grafts there was no significant difference between the prevalence of vascular diseases 5 years after SPKN and KTA [14]. Hence, it was concluded that SPKT reduces cardiovascular risk factors but does not halt progression of macrovascular diseases during the first 5 years after transplantation.…”

Section: Introductionmentioning

confidence: 96%

Progression of macrovascular diseases is reduced in type 1 diabetic patients after more than 5 years successful combined pancreas-kidney transplantation in comparison to kidney transplantation alone

Biesenbach¹,

Königsrainer²,

Gross³

et al. 2005

Transplant Int

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100

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SummaryRecent reports have demonstrated an improved cardiovascular outcome after simultaneous pancreas-kidney transplantation (SPKT) compared with kidney transplantation alone (KTA) in type 1 diabetic patients with end-stage renal disease. The purpose of this study was to determine the impact of SKPT and KTA on the progression of cerebrovascular disease (CVD), coronary heart disease (CHD) and peripheral vascular disease (PVD) 5 and 10 years after transplantation. Only patients with graft survival more than 5 years, were included in this study. In summary, 12 type 1 diabetic patients with SPKT and 10 diabetic subjects with KTA were evaluated. The immunosuppressive therapy was similar in both patient groups. The mean observation period was 124 (72-184) months in the SPKT group and 122 (64-216) months in the group with KTA. To investigate the vascular risk profile we examined mean HbA1c, blood pressure and lipid levels in both patient groups during the first 5 years (period I) and the second 5 years (period II) after transplantation (measurements at least at 3-month intervals). Additionally, we evaluated the prevalence of moderate (stage I-II) and severe (stage III-IV) macrovascular diseases prior as well as 5 and 10 years after transplantation. During period I the mean HbA1c-value was 5.7 ± 0.4% in the group with SPKT versus 7.4 ± 0.8% in the KTA group, and in period II 5.8 ± 0.4% in the SPKT group versus 7.6 ± 0.9% (P < 0.001) in the patients with KTA. The cholesterol levels were approximately the same in both groups, the triglycerides were lower in the patients with SPKT than in the subjects with KTA with 1.3 ± 0.4 vs. 2.2 ± 0.9 mmol/l in period I, and 1.4 ± 0.5 vs. 2.3 ± 0.6 mmol/l in period II (P < 0.05). The BP-values were similar in both groups. Five years after transplantation the prevalence of vascular diseases was not significantly different between both groups. During the following 5 years the prevalence of macrovascular diseases increased more in the KTA than in the SKPT group. After a mean observation period of 10 years the SKPT group showed a lower prevalence of vascular diseases (stage I-IV) with 41% CVD, 50% CHD and 50% PAV in comparison to the KTA group with a prevalence of 80% CVD, 90% CHD and 80% PAV), the difference was not statistically significant because of the small patient groups. The frequency of the vascular complications myocardial infarction (16% vs. 50%), stroke (16% vs.

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

Cited by 36 publications

References 11 publications

Long-term cardiovascular outcomes in type 1 diabetic patients after simultaneous pancreas and kidney transplantation compared with living donor kidney transplantation

Long-term cardiovascular outcomes in type 1 diabetic patients after simultaneous pancreas and kidney transplantation compared with living donor kidney transplantation

Macrovascular disease after simultaneous pancreas and kidney transplantation

Progression of macrovascular diseases is reduced in type 1 diabetic patients after more than 5 years successful combined pancreas-kidney transplantation in comparison to kidney transplantation alone

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