Diabetic microangiopathy in Type 1 (insulin-dependent) diabetic patients after successful pancreatic and kidney or solitary kidney transplantation

Abendroth, D.; Schmand, J.; Landgraf, R.; Illner, Wolf–Dieter; Land, W.

doi:10.1007/bf00587639

Cited by 29 publications

(22 citation statements)

References 5 publications

(1 reference statement)

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“…This is in line with a number of previous studies on microcirculatory changes after pancreatic grafting using different methods for microcirculation assessment [28][29][30][31]. In contrast to these findings are the results of studies based on transcutaneous oxygen tension measurement [51] as well as on videophotometric capillaroscopy and a laser Doppler method [50] showing no positive changes in microcirculation after successful pancreas transplantation.…”

Section: Discussionsupporting

confidence: 85%

“…In contrast to these findings are the results of studies based on transcutaneous oxygen tension measurement [51] as well as on videophotometric capillaroscopy and a laser Doppler method [50] showing no positive changes in microcirculation after successful pancreas transplantation. In diabetic kidney recipients, there was also an improvement of microcirculation; however, this was not as pronounced as in patients after successful pancreas and kidney transplantation [29]. These changes occur rather early posttransplant, suggesting functional rather than structural improvements of skin microcirculation.…”

Section: Discussionmentioning

confidence: 70%

“…Positive effects of a long-term blood glucose normalization on diabetic secondary complications have been reported especially for diabetic sensory-motor polyneuropathy [21][22][23][24], autonomic neuropathy [23][24][25] and diabetic nephropathy [20,26,27]. There have also been reports on an improvement of the skin microcirculation measured by laser Doppler fluxmetry [28], laser speckle method [29], intravital capillaroscopy [28,30], telethermography [31] and transcutaneous oxygen tension measurement [29,31].…”

Section: Introductionmentioning

confidence: 97%

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Blood flow in the skin of type 1 diabetic patients before and after combined pancreas/kidney transplantation

Eberl¹,

Piehlmeier²,

Dachauer³

et al. 2005

Diabetes Metab. Res. Rev.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Blood flow in the skin of type 1 diabetic patients before and after combined pancreas/kidney transplantation

Eberl¹,

Piehlmeier²,

Dachauer³

et al. 2005

Diabetes Metab. Res. Rev.

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“…It is our impression, however, that normal pancreas graft function also has a positive effect on diabetic neuropathy which was seen by others as well [ 12,13]. It has been shown by still another group that peripheral microcirculation improved after transplantation [14,15]. Proteinuria in our patients with a functioning pancreas graft is caused by chronic rejec tion rather than by diabetic nephropathy as demonstrated by histology and also described by others [16].…”

Section: Discussionmentioning

confidence: 54%

Experience with 100 Combined Pancreatic Renal Transplantations in a Single Center

Landro

Koenigsrainer²,

Oefner³

et al. 1996

Nephron

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Compared to the still increasing number of kidney, liver and heart transplants performed worldwide, pancreas transplantation remains a rare occurrence. At our center a pancreas transplant program was began in late 1979. Since then a total of 113 pancreas transplants were performed in 106 patients, 100 of them also received a kidney from the same donor. The first group consisted of 5 patients with immediate duct occlusion (IDO). In the second group (n = 8) the pancreatic juice of the segmental graft was diverted into a Roux-Y loop of jejunum. Because of two fatal technique-associated complications, delayed duct occlusion was introduced and applied in 15 patients. Because of a prolonged hospitalization period due to local complications, the surgical technique was changed again. From 1987, 72 segmental pancreatic transplants with bladder drainage were performed and finally one whole organ with a duodenal segment was transplanted. Immunosuppression consisted of cyclosporine A, azathioprine and prednisolone from 1984 on. Rejection episodes were treated with high-dose methylprednisolone on 3 consecutive days and steroid-resistant rejections with ATG. The overall patient survival at 6 years was 80%, renal allograft survival 72% and pancreas graft survival 63% for the entire group. In the delayed duct occlusion group, 1-year patient and kidney graft survival of 93% each and 79% for the pancreas was calculated. One-year survival in the most recent and largest group with bladder drainage was 89% for patients, 86% for the kidney and 75 % for the pancreas. Excellent metabolic control was achieved in the majority of patients with mean C-peptide levels and HbA1C levels at 6 months of 1.46 pmol/ml and 5.6%, respectively. Successful pancreas transplants with normalization of carbohydrate metabolism seem to have a beneficial effect on secondary complications of diabetes, contributing to the high degree of rehabilitation of these patients.

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“…Interestingly, in this case, the eventual progression of microvascular disease takes place only in kidney-alone patients and not in kidneypancreas patients. A positive effect of pancreas transplant on microcirculation was already reported (28).…”

Section: Hypertension and Metabolic Statusmentioning

confidence: 84%

Reversal of left ventricular diastolic dysfunction after kidney-pancreas transplantation in type 1 diabetic uremic patients.

et al. 2000

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RESULTS -The left ventricular ejection fraction was normal in all of the patients. However, kidney-pancreas transplant patients with 4 years of graft function had a higher ejection fraction (75.7 ± 1.8%) than kidney-alone patients with 4 years of graft function (65.3 ± 2.8%, P = 0.02) and type 1 diabetic patients (61.3 ± 3.7%, P = 0.004). In patients with 4 years of graft function, normal diastolic parameters were evident in kidney-pancreas but not in kidney-alone or in type 1 diabetic patients (peak filling rate: 4.46 ± 0.15 end diastolic volume (EDV)/s in kidney-pancreas patients vs. 2.73 ± 0.24 EDV/s [P Ͻ 0.01] and 3.39 ± 0.30 EDV/s [P Ͻ 0.01] in kidney-alone and type 1 diabetic patients, respectively; time-to-peak filling rate: 141.9 ± 7.8 ms in kidney-alone patients vs. 209.4 ± 13.5 ms in kidney-alone patients [P Ͻ 0.01]; peak filling rate/peak ejection rate ratio: 1.10 ± 0.04 in kidney-pancreas patients vs. 0.81 ± 0.08 in kidneyalone patients [P Ͻ 0.01]). A significant reduction in diastolic dysfunction rate was observed only in kidney-pancreas patients.CONCLUSIONS -Kidney-pancreas transplantation results in complete insulin independence, a better glycometabolic pattern and blood pressure control, an improvement of left ventricular function, and a reversal of diastolic dysfunction. E m e r g i n g T r e a t m e n t s a n d T e c h n o l o g i e s

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Diabetic microangiopathy in Type 1 (insulin-dependent) diabetic patients after successful pancreatic and kidney or solitary kidney transplantation

Cited by 29 publications

References 5 publications

Blood flow in the skin of type 1 diabetic patients before and after combined pancreas/kidney transplantation

Blood flow in the skin of type 1 diabetic patients before and after combined pancreas/kidney transplantation

Experience with 100 Combined Pancreatic Renal Transplantations in a Single Center

Reversal of left ventricular diastolic dysfunction after kidney-pancreas transplantation in type 1 diabetic uremic patients.

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