Renal Transplantation in Patients With Insulin-Dependent Diabetes

Kjellstrand, C.M.; Goetz, F. C.; Shideman, J. R.; Simmons, R. L.; Buselmeier, T. J.; Hartitzsch, B. von; Najarian, J. S.

doi:10.1016/s0140-6736(73)91944-2

Cited by 63 publications

(32 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…21 A series of kidney transplants alone (KTA) from living or cadaver donors was initiated in uremic diabetic patients, as reported to the American Surgical Association, 22,23 ultimately producing a large number of candidates 24 for pancreas after kidney (PAK) transplants in era 1. 4 Lillehei switched to doing PTA in nonuremic diabetic patients but had only three cases, and all grafts were rejected within 3 months.…”

Section: Description Of Eras Eramentioning

confidence: 99%

Lessons Learned From More Than 1,000 Pancreas Transplants at a Single Institution

Sutherland¹,

Gruessner²,

Dünn³

et al. 2001

Annals of Surgery

612

434

View full text Add to dashboard Cite

ObjectiveTo determine outcome in diabetic pancreas transplant recipients according to risk factors and the surgical techniques and immunosuppressive protocols that evolved during a 33-year period at a single institution. Summary Background DataInsulin-dependent diabetes mellitus is associated with a high incidence of management problems and secondary complications. Clinical pancreas transplantation began at the University of Minnesota in 1966, initially with a high failure rate, but outcome improved in parallel with other organ transplants. The authors retrospectively analyzed the factors associated with the increased success rate of pancreas transplants. MethodsFrom December 16, 1966, to March 31, 2000, the authors performed 1,194 pancreas transplants (111 from living donors; 191 retransplants): 498 simultaneous pancreas-kidney (SPK) and 1 simultaneous pancreas-liver transplant; 404 pancreas after kidney (PAK) transplants; and 291 pancreas transplants alone (PTA). The analyses were divided into five eras: era 0, 1966 to 1973 (n ϭ 14), historical; era 1, 1978 to 1986 (n ϭ 148), transition to cyclosporine for immunosuppression, multiple duct management techniques, and only solitary (PAK and PTA) transplants; era 2, 1986 to 1994 (n ϭ 461), all categories (SPK, PAK, and PTA), predominately bladder drainage for graft duct management, and primarily triple therapy (cyclosporine, azathioprine, and prednisone) for maintenance immunosuppression; era 3, 1994 to 1998 (n ϭ 286), tacrolimus and mycophenolate mofetil used; and era 4, 1998 to 2000 (n ϭ 275), use of daclizumab for induction immunosuppression, primarily enteric drainage for SPK transplants, pretransplant immunosuppression in candidates awaiting PTA. ResultsPatient and primary cadaver pancreas graft functional (insulinindependence) survival rates at 1 year by category and era were as follows: SPK, era 2 (n ϭ 214) versus eras 3 and 4 combined (n ϭ 212), 85% and 64% versus 92% and 79%, respectively; PAK, era 1 (n ϭ 36) versus 2 (n ϭ 61) versus 3 (n ϭ 84) versus 4 (n ϭ 92), 86% and 17%, 98% and 59%, 98% and 76%, and 98% and 81%, respectively; in PTA, era 1 (n ϭ 36) versus 2 (n ϭ 72) versus 3 (n ϭ 30) versus 4 (n ϭ 40), 77% and 31%, 99% and 50%, 90% and 67%, and 100% and 88%, respectively. In eras 3 and 4 combined for primary cadaver SPK transplants, pancreas graft survival rates were significantly higher with bladder drainage (n ϭ 136) than enteric drainage (n ϭ 70), 82% versus 74% at 1 year (P ϭ .03). Increasing recipient age had an adverse effect on outcome only in SPK recipients. Vascular disease was common (in eras 3 and 4, 27% of SPK recipients had a pretransplant myocardial infarction and 40% had a coronary artery bypass); those with no vascular disease had significantly higher patient and graft survival rates in the SPK and PAK categories. Living donor segmental pancreas transplants were associated with higher technically successful graft survival rates in each era, predominately solitary (PAK and PTA) in eras 1 and 2 and SPK in eras 3 and 4. Diabetic seconda...

show abstract

Section: Description Of Eras Eramentioning

confidence: 99%

Lessons Learned From More Than 1,000 Pancreas Transplants at a Single Institution

Sutherland¹,

Gruessner²,

Dünn³

et al. 2001

Annals of Surgery

612

434

View full text Add to dashboard Cite

show abstract

“…More experience with such patients has resulted in few problems in recent years [74], In many centers, bilateral nephrectomy has been dis continued in both diabetics and nondiabetics. In the former group of patients, this procedure appears to ad versely affect survival [79,[86][87][88], It is now recom mended that only those diabetics with uncontrollable hypertension, severe recurrent renal infection or debili tating protein loss be subjected to bilateral nephrectomy [79],…”

Section: Morbidity Factorsmentioning

confidence: 99%

Diabetic Nephropathy: Natural Course, Survivorship and Therapy

1981

View full text Add to dashboard Cite

Diabetes mellitus is a disease with major social and economic consequences. End-stage renal disease (ESRD) due to diabetes occurs in as many as 30% of patients with juvenile diabetes, providing a large percentage (up to 33%) of all patients in need of therapy for ESRD. We have reviewed the natural course of the nephropathy in type I diabetes mellitus and the results of dialysis and transplantation therapy with particular regard to survival and morbidity. Comparisons of the survival of diabetic patients among peritoneal dialysis, hemodialysis, and transplantation are complicated by the lack of sufficient data for peritoneal dialysis and by the bias introduced by patient/treatment selection methods. Presently, it appears that transplantation with a living related donor graft offers the best survival for both graft and patient, with a definite reduction of morbidity associated with the complications of diabetes. Cadaveric transplantation is approximately the equivalent of hemodialysis in patient survival at 1 year and also appears to offer a somewhat diminished morbidity. Peritoneal dialysis data are sparse and skewed by patient selection. However, there is some emerging evidence that therapy with this modality may be associated with a delay in progression of retinopathy, when compared with hemodialysis.

show abstract

“…Recently N a ja ria n and his colleagues [72,[96][97][98] have summarized the results of 59 kidney transplants in 53 diabetic patients. 38 are still alive with functioning grafts.…”

Section: Late Abnormalitiesmentioning

confidence: 99%

Insulin and the Kidney

Rubenstein

Mako

Horwitz

1975

Nephron

View full text Add to dashboard Cite

Changes in renal function and structure are frequently observed in patients with diabetes mellitus. In the early phases of the disease, alterations in glomerular filtration rate, renal plasma flow, glomerular permeability and tubular capacity for glucose reabsorption occur. In the late stages of juvenile onset diabetes, renal failure is a common cause of death. For this reason, increasing attention is being paid to the possibility of long-term dialysis and renal transplantation in these patients. The kidneys play an important role in regulating insulin metabolism. The renal arteriovenous difference is approximately 30–45% and a linear relationship exists between the arterial insulin level and the renal arteriovenous concentration difference. The renal extraction of insulin is 200 ml/min in man, and it is estimated that 6–8 U are removed and degraded by the kidney in 24 h. The quantity of insulin in urine is small. However, its clearance is relatively constant over a wide range of serum concentrations and is 0.15–0.5 ml/min. The mean basal insulin excretion is 3.6 µU/mg creatinine, and a fourfold rise occurs following a glucose load. The urinary insulin values in neonates, children and patients with diabetes and renal failure are reviewed. In diabetic patients, progressive renal disease is accompanied by decreasing insulin requirements. In contrast, nondiabetic patients who develop renal failure frequently show abnormalities in carbohydrate metabolism, the commonest of which is a pseudodiabetic state.

show abstract

Renal Transplantation in Patients With Insulin-Dependent Diabetes

Cited by 63 publications

References 5 publications

Lessons Learned From More Than 1,000 Pancreas Transplants at a Single Institution

Lessons Learned From More Than 1,000 Pancreas Transplants at a Single Institution

Diabetic Nephropathy: Natural Course, Survivorship and Therapy

Insulin and the Kidney

Contact Info

Product

Resources

About