Results of Pancreas Transplantation Alone with Special Attention to Native Kidney Function and Proteinuria in Type 1 Diabetes Patients
Ugo Boggi , Fabio Vistoli , Gabriella Amorese, Stefano Signori , Nelide De Lio,Division of General and Transplant Surgery in Uremic and Diabetic Patients, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
Rosa Giannarelli , Alberto Coppelli, Alberto Piaggesi , Anna Tedeschi, Margherita Occhipinti , Emanuela Mangione, Stefano Del Prato, Piero MarchettiDepartment of Endocrinology and Metabolism, University of Pisa, Pisa, Italy
Rita Mariotti, Lorenzo RondininiDivision of Cardiology, Cardiac and Thoracic Depart-ment, University of Pisa, Pisa, Italy.
Massimiliamo Barsotti, Diego CantarovichDepartment of Nephrology, Transplantation and Dialysis 1, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Franco MoscaDepartment of Oncology, Transplants and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy.
We report on our single-center experience with pancreas transplantation alone (PTA) in 71 patients with type 1 diabetes, and a 4-year follow-up. Portal insulin delivery was used in 73.2% of cases and enteric drainage of exocrine secretion in 100%. Immunosuppression consisted of basiliximab (76%), or thymoglobulin (24%), followed by mycophenolate mofetil, tacrolimus, and low-dose steroids. Actuarial patient and pancreas survival at 4 years were 98.4% and 76.7%, respectively. Relaparatomy was needed in 18.3% of patients. Restored endogenous insulin secretion resulted in sustained normalization of fasting plasma glucose levels and HbA1c concentration in all technically successful transplantations. Protenuria (24-hour) improved significantly after PTA. Renal function declined only in recipients with pretransplant glomerular filtration rate (GFR) greater than 90 ml/min, possibly as a result of correction of hyperfiltration following normalization of glucose metabolism. Further improvements were recorded in several cardiovascular risk factors, retinopathy, and neuropathy. We conclude that PTA was an effective and reasonably safe procedure in this single-center experience.
Keywordsdiabetes · pancreas transplantation · retinopathy · diabetic nephropathy · diabetic neuropathy · glomerular filtration rate · proteinuria,.
Rev Diabet Stud