Increasing prevalence of cardiovascular disease in kidney transplant patients with Type 1 diabetes

Carlström, Jan; Nordén, Gunnela; Mjörnstedt, L.; Nyberg, Gudrun

doi:10.1007/s001470050207

Cited by 4 publications

(2 citation statements)

References 24 publications

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“…The high mortality rate, mainly of cardiovascular disease, found among our SPK recipients is in accordance with most previous studies on the outcome of kidney transplantation alone to patients with type 1 diabetes (12, 13). The outcome was not better for the SPK recipients than for the entire contemporary population of CD kidney graft recipients, although this population was significantly older and had older donors.…”

Section: Discussionsupporting

confidence: 92%

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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Section: Discussionsupporting

confidence: 92%

Macrovascular disease after simultaneous pancreas and kidney transplantation

Nordén

Carlström

Wramner

et al. 2004

Clinical Transplantation

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“…That policy follows the recommendation not to favour one patient group over another [14] and aims to present all patients with an equal opportunity for renal transplantation. Even though graft survival in diabetic patients here, as in other centres, approximates that of non-diabetic patients, the survival rate of the former group is indeed inferior [5,15,161. Preliminary results here, with regard to overall diabetic patient material, suggest that the waiting time for transplanted diabetic patients is similar to that of other patient groups.…”

Section: Discussionmentioning

confidence: 90%

Why do some diabetic patients on the kidney transplant waiting list not receive a transplant?

Kyllönen

Salmela

2004

Transplant Int

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The waiting list (WL) history of 405 diabetic patients placed on the kidney transplantation WL for the years 1993-2000 was examined. By 31 December 2000, 295 (73 %) patients had received a transplant. Of the remaining 110 patients 53 (13 %) were still on the WL; 27 of these were temporarily withdrawn, i.e. non-active, 46 others (1 1 %) had died and I1 (3 %) had been permanently removed. Patient follow-up continued until the end of 2002. Although the mean total time on the WL of the non-transplanted was twice that of the transplanted patients there were no significant differences in the mean active times on the WL. The mean cumulative withdrawal time of the transplanted and those on the active WL was less than 10 % of their total time on the list, but for the patients who had died or were withdrawn on 31 December 2000 it exceeded 50 %, usually because of diabetic complications. The 5-year survival of the transplanted patients was greatly superior to that of the non-transplanted, as expected. However, the better survival of the transplanted patients is not necessarily proof of a better treatment modality but rather a consequence of the exclusion from transplantation of patients suffering from diabetic complications. It is not justified to compare the survival of transplantable and non-transplantable WL patients.

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Pancreas transplants for diabetic nephropathy: A time for reassessment

Lederer

2000

American Journal of Kidney Diseases

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Increasing prevalence of cardiovascular disease in kidney transplant patients with Type 1 diabetes

Cited by 4 publications

References 24 publications

Macrovascular disease after simultaneous pancreas and kidney transplantation

Macrovascular disease after simultaneous pancreas and kidney transplantation

Why do some diabetic patients on the kidney transplant waiting list not receive a transplant?

Pancreas transplants for diabetic nephropathy: A time for reassessment

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