Results of Pancreas Transplantation Alone with Special Attention to Native Kidney Function and Proteinuria in Type 1 Diabetes Patients

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Abstract
The Review of Diabetic Studies,2011,8,2,259-267.
Published:August 2011
Type:Original Article
Authors:
Author(s) affiliations:

Ugo Boggi1, Fabio Vistoli1, Gabriella Amorese1, Rosa Giannarelli2, Alberto Coppelli2, Rita Mariotti3, Lorenzo Rondinini3, Massimiliamo Barsotti4, Alberto Piaggesi2, Anna Tedeschi2, Stefano Signori1, Nelide De Lio1, Margherita Occhipinti2, Emanuela Mangione2, Diego Cantarovich4, Stefano Del Prato2, Franco Mosca5, and Piero Marchetti2,6

1Division of General and Transplant Surgery in Uremic and Diabetic Patients, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.

2Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy.

3Division of Cardiology, Cardiac and Thoracic Department, University of Pisa, Pisa, Italy.

4Department of Nephrology, Transplantation and Dialysis 1, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.

5Department of Oncology, Transplants and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy.

6Unit of Endocrinology and Metabolism of Transplantation, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.

Abstract:

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.