Effect of pancreas transplantation on life expectancy, kidney function and quality of life in uraemic Type 1 (insulin-dependent) diabetic patients

Secchi, Antonio; Carlo, V. Di; Martinenghi, Sabina; Rocca, E. La; Caldara, Rossana; Spotti, D.; Slaviero, Giorgio; Staudacher, C.; Ferrari, Giovanni; Pozza, G.

doi:10.1007/bf00587642

Cited by 27 publications

(6 citation statements)

References 8 publications

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“…Pancreas transplantation permits complete insulin independence; creates normal glycometabolic control (7); slows or reverses diabetic nephropathy (8), retinopathy (9), and neuropathy (10); and improves the quality of life (7,11). Furthermore, the tight metabolic control achieved with kidneypancreas transplantation does not expose patients to severe hypoglycemic episodes (7).…”

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confidence: 99%

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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confidence: 99%

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

et al. 2000

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“…The most important consideration is that the life expectancy of diabetic uremic patients on hemodialysis is remarkably reduced, compared with patients affected by end-stage renal disease of other causes, and is good after pancreas and kidney transplantation: the 5-year diabetic and nondiabetic patient survival rate on hemodialysis (for patients started on dialysis at 25-44 years of age) is ~4 0 and 75%, respectively (20). Conversely, the 5-year diabetic patient survival rate after pancreas and kidney transplantation is as high as 89% (21), and the one-year survival rate of the patient and of the kidney transplanted into the diabetic patient is as high as in nondiabetic individuals (91.6 and 79% vs. 94 and 80%, respectively) (19,22). Therefore, once the diabetic patient is submitted to kidney transplantation, the maximum effort must be made to preserve kidney function, because the patients risk of death while on a waiting list is very high; that is to say, nondiabetic patients can survive for a long time on dialysis, while diabetic patients cannot.…”

Section: Cancer After Pancreas Transplantationmentioning

confidence: 91%

Cancer Arising After Pancreas and/or Kidney Transplantation in a Series of 99 Diabetic Patients

et al. 1997

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“…All surveys to date show that successful pancreas transplant recipients experience improvements in quality of life [34][35][36][37][38]. In part, this reflects how much diabetic patients enjoy being relieved from a constant focus on food, glucose monitoring, and insulin shots, but also reflects the benefits of sustained, normalized glucose with fewer glucose excursions.…”

Section: Quality Of Lifementioning

confidence: 99%

Pancreas and kidney transplantation

2002

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Kidney transplantation is preferred over dialysis for management of end-stage renal disease complicating type I or type 2 diabetes, for those who are eligible. Simultaneous pancreas-kidney (SPK) or pancreas after kidney transplantation (PAK) is an important alternative to kidney transplantation alone for type I diabetes patients if the patient is able to withstand the additional risks of these procedures, because of the benefits of glucose control on other diabetic complications. Pancreas transplantation alone (PTA) is most useful for the treatment of debilitating, frequent hypoglycemia complicating type I diabetes, if renal function is adequate. One-year pancreas graft survival is best after SPK (82%) but has significantly improved after both PAK (74%) and PTA (76%). The I-year kidney graft and patient survival rates after SPK are similar to kidney transplantation alone. Pancreas transplantation normalizes glucose beyond what can be achieved with insulin therapy and has been shown to decrease progression of or improve most, if not all, diabetic end-organ complications using current immunosuppression regimens. However, the diabetologist and endocrinologist should remain involved in the care of the pancreas or kidney transplant recipient for treatment of vascular disease risk factors such as dyslipidemia, surveillance of other diabetic complications including foot ulcers, surveillance and treatment of bone loss, and management of hyperglycemia if it recurs.

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Effect of pancreas transplantation on life expectancy, kidney function and quality of life in uraemic Type 1 (insulin-dependent) diabetic patients

Cited by 27 publications

References 8 publications

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

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

Cancer Arising After Pancreas and/or Kidney Transplantation in a Series of 99 Diabetic Patients

Pancreas and kidney transplantation

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