Article

Simultaneous pancreas-kidney transplantation reduces excess mortality in type 1 diabetic patients with end-stage renal disease.

Departments of Medicine and Surgery, University of Wisconsin, Madison 53792, USA.
Kidney International (Impact Factor: 8.52). 05/2000; 57(5):2129-35. DOI: 10.1046/j.1523-1755.2000.00064.x
Source: PubMed

ABSTRACT Diabetic renal disease continues to be the most significant cause of end-stage renal disease (ESRD) in the United States. Renal transplantation improves diabetic ESRD patient survival; however, the diabetic state remains associated with poor patient survival. Simultaneous pancreas-kidney (SPK) transplantation can restore normoglycemia and thus may improve outcomes.
We assessed the impact of SPK on age-range-matched type 1 diabetic patients who underwent renal transplantation at a single center. The observed/expected life span and annual mortality rates (AMRs) were used as measures of survival. A Cox proportional hazards analysis was used to analyze the impact of potential variables on mortality in SPK recipients.
SPK transplantation (N = 335) increased the observed/expected life span compared with diabetic cadaveric (DM-Cad, N = 147) and live-donor (DM-Live, N = 160) transplant recipients (P = 0.004) and significantly reduced the AMRs (SPK, 1. 5%; DM-Cad, 6.27%; DM-Live, 3.65%, P = 0.008, SPK vs. other DM). Moreover, the SPK observed/expected life span and AMR were not significantly different from that of age-range-matched nondiabetic transplant recipients (N = 492). The only variable that was significantly associated with patient survival was discharge serum creatinine (relative risk 1.16, P < or = 0.0154).
These data demonstrate that SPK improves the ability for type 1 diabetic patients to live more of their expected life span. This suggests that glycemic control, even as a late intervention in a diabetic patient's lifetime, may beneficially affect survival.

0 Bookmarks
 · 
65 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Die Pankreastransplantation stellt heute eine effektive und erfolgreiche Therapiemaßnahme zur Kontrolle des Glukosestoffwechsels dar. Aufgrund der postoperativen Morbidität und der notwendigen Immunsuppression sollte sie im Wesentlichen bei diabetischen Patienten, welche gleichzeitig eine Nierentransplantation benötigen, zur Anwendung kommen. Ferner kann die Indikation zur alleinigen Pankreastransplantation bei Patienten mit nicht akzeptabler Stoffwechselkontrolle und schlechter Lebensqualität trotz optimaler medikamentöser Therapie in Betracht gezogen werden. Seit kurzer Zeit stellt die Inselzelltransplantation eine gering invasive Alternative zur Pankreastransplantation dar. Aufgrund der wenigen Langzeitdaten und des derzeit noch ungünstigen Spender-Empfänger-Verhältnisses sollte sie wenigen erfahrenen Zentren im Rahmen klinisch-experimenteller Protokolle vorbehalten bleiben. Neue Verfahren zum Schutz transplantierter Inseln und zur Induktion einer spenderspezifischen Toleranz könnten den Indikationskreis erheblich erweitern, so dass dann alternative Quellen zur Generierung von -Zellen benötigt werden.
    Der Internist 01/2004; 45(11). DOI:10.1007/s00108-004-1303-7 · 0.27 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Individuals with chronic kidney disease (CKD) are at increased risk for the development and progression of cardiovascular disease (CVD). The increased risk is due to a higher prevalence of both traditional risk factors as well as nontraditional risk factors. In this review we focus on individuals at all stages of CKD and discuss modifiable traditional risk factors, namely hypertension, dyslipidemia, diabetes mellitus and poor glycemic control, smoking, and physical inactivity. The prevalence of each risk factor and its relationship with CVD is described. Treatment recommendations are provided using evidence available from populations with CKD or evidence extrapolated from the general population when there are insufficient data on individuals with CKD.
    Seminars in Dialysis 03/2003; 16(2). DOI:10.1046/j.1525-139X.2003.16028.x · 2.25 Impact Factor
  • Source

Preview

Download
0 Downloads
Available from