Effects of simultaneous pancreas-kidney transplantation and kidney transplantation alone on the outcome of peripheral vascular diseases

Abstract

BackgroundThe effects of Simultaneous Pancreas Kidney Transplantation (SPKT) on Peripheral Vascular Disease (PVD) warrants additional study and more target focus, since little is known about the mid- and long-term effects on the progression of PVD after transplantation.Methods101 SPKT and 26 Kidney Transplantation Alone (KTA) recipients with insulin-dependent diabetes mellitus (IDDM) were retrospectively evaluated with regard to graft and metabolic outcome. Special subgroup analysis was directed towards the development and progression of peripheral vascular complications (PVC) (amputation, ischemic ulceration, lower extremity angioplasty/ bypass surgery) after transplantation.ResultsThe 10-year patient survival was significantly higher in the SPKT group (SPKT: 82% versus KTA 40%; P < 0.001). KTA recipients had a higher prevalence of atherosclerotic risk factors, including coronary artery disease (P < 0.001), higher serum triglyceride levels (P = 0.049), higher systolic (P = 0.03) and diastolic (P = 0.02) blood pressure levels. The incidence of PVD before transplantation was comparable between both groups (P = 0.114). Risk factor adjusted multivariate analysis revealed that patients with SPKT had a significant lower amount (32%) of PVCs (32 PVCs in 21 out of 101 SPKT; P < 0.001) when compared to the KTA patients who developed a significant increase in PVCs to 69% of cases (18 PVCs in 11 out of 26 KTA; P < 0.001). In line mean values of HbA1c (P < 0.01) and serum triglycerides (P < 0.01) were significantly lower in patients with SPKT > 8 years after transplantation.ConclusionSPKT favorably slows down development and progression of PVD by maintaining a superior metabolic vascular risk profile in patients with IDDM1.

Short and long-term metabolic outcomes in patients with type 1 and type 2 diabetes receiving a simultaneous pancreas kidney allograft

“…Immunosuppression protocol of our center consisted of an induction therapy, maintenance immunosuppression with a calcineurininhibitor (CNI) (mostly tacrolimus), an antimetabolite (mostly mycophenolate mofetile (MMF) or sirolimus (SRL)) and steroids [26].…”

“…As standard induction therapy, patients usually received antithymocyte globulin (ATG) with an initial dose of 4 mg/kg body weight before transplantation and followed by 1-1.5 mg/kg body weight on postoperative days 1-3 [26].…”

“…In addition, patients received MMF at an oral dose of 1 g twice daily. Steroid-tapering was done according to the protocol, aiming at discontinuation one year after transplantation [26].…”

Pre-operative ankle–brachial index for cardiovascular risk assessment in simultaneous pancreas–kidney transplant recipients: a simple and elegant strategy!

“…The procurement and transplantation of pancreatic and kidney allografts were performed according to international standard and guidelines, as previously described [31][32][33][34][35][36][37]. The standard immunosuppression protocol at our center consisted of an induction therapy followed by triple maintenance medicamentous therapy, as described previously [36,37].…”

“…Data from our prospectively maintained database have been previously published [36,37]. However, these publications addressed different scienti c topics and comprised different subsets of patients.…”