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; Rosa Giannarelli; Alberto Coppelli; Rita Mariotti; Lorenzo Rondinini; Massimiliamo Barsotti; Alberto Piaggesi; Anna Tedeschi; Stefano Signori; Nelide De Lio; Margherita Occhipinti; Emanuela Mangione; Diego Cantarovich; Stefano Del Prato; Franco Mosca; Piero Marchetti

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Abstract

The Review of Diabetic Studies,2011,8,2,259-267.

DOI:10.1900/RDS.2011.8.259

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 Marchetti^2,6

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.

Keywords:Diabetes, Diabetic nephropathy, Diabetic neuropathy, Glomerular filtration rate, Pancreas transplantation, Proteinuria, Retinopathy