Long-Term (5 Years) Efficacy and Safety of Pancreas Transplantation Alone in Type 1 Diabetic Patients
ABSTRACT Although combined pancreas and kidney transplantation is an established procedure for the treatment of type 1 diabetes (T1D) in patients with end-stage renal disease, the role of pancreas transplant alone (PTA) in the therapy of T1D subjects with preserved kidney function is still matter of debate.
We report our single-center experience of PTA in 71 consecutive T1D patients all with a posttransplant follow-up of 5 years. Patient and pancreas (normoglycemia in the absence of any antidiabetic therapy) survivals were determined, and several clinical parameters (including risk factors for cardiovascular diseases) were assessed. Cardiac evaluation and Doppler echocardiographic examination were also performed, and renal function and proteinuria were evaluated.
Actual patient and pancreas survivals at 5 years were 98.6% and 73.2%, respectively. Relaparotomy was needed in 18.3% of cases. Restoration of endogenous insulin secretion was accompanied by sustained normalization of fasting plasma glucose concentrations and HbA1c levels as well as significant improvement of total cholesterol, low-density lipoprotein-cholesterol, and blood pressure. An improvement of left ventricular ejection fraction was also observed. Proteinuria (24 hours) decreased significantly after transplantation. One patient developed end-stage renal disease. In the 51 patients with sustained pancreas graft function, kidney function (serum creatinine and glomerular filtration rate) decreased over time with a slower decline in recipients with pretransplant glomerular filtration rate less than 90 mL/min.
PTA was an effective and reasonably safe procedure in this single-center cohort of T1D patients.
- SourceAvailable from: Daniele Focosi
Article: Transplantation of the Pancreas[Show abstract] [Hide abstract]
ABSTRACT: Pancreas transplantation consistently induces insulin-independence in beta-cell-penic diabetic patients, but at the cost of major surgery and life-long immunosuppression. One year after grafting, patient survival rate now exceeds 95 % across recipient categories, while insulin independence is maintained in some 85 % of simultaneous pancreas and kidney recipients and in nearly 80 % of solitary pancreas transplant recipients. The half-life of the pancreas graft currently averages 16.7 years, being the longest among extrarenal grafts, and substantially matching the one of renal grafts from deceased donors. The difference between expected (100 %) and actual insulin-independence rate is mostly explained by technical failure in the postoperative phase, and rejection in the long-term period. Death with a functioning graft remains a further major issue, especially in uremic patients who have undergone prolonged periods of dialysis. Refinements in graft preservation, surgical techniques, immunosuppression, and prophylactic treatments are expected to further improve the results of pancreas transplantation.Current Diabetes Reports 07/2012; 12(5):568-79. DOI:10.1007/s11892-012-0293-4 · 3.08 Impact Factor
Article: La transplantation pancréatique[Show abstract] [Hide abstract]
ABSTRACT: Pancreas transplantation is one of the possible therapeutic approaches in type 1 diabetes (T1D). Expected benefits must outweigh the potentially severe complications which can be related to the surgical procedure and to long-term immunosuppressive therapy, and decision must be taken by an experienced multidisciplinary team. The most frequent indication is simultaneous pancreas-kidney transplantation in a patient with T1D and severe diabetic nephropathy, either on dialysis or, preferably, before end-stage renal disease (pre-emptive transplantation). But pancreas transplantation alone should also be considered in patients with brittle diabetes endangering vital prognosis through acute metabolic complications and responsible for poor quality of life.Médecine des Maladies Métaboliques 11/2012; 6(5):389–395. DOI:10.1016/S1957-2557(12)70443-1
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ABSTRACT: Purpose of review: Successful pancreas transplantation restores physiologic glycemic and metabolic control. Its effects on overall patient survival (especially for simultaneous pancreas-kidney transplantation) are clear-cut. We herein review the available literature to define the impact of pancreas transplantation on chronic complications of diabetes mellitus. Recent findings: With longer-term follow-up, wider patient populations, and more accurate investigational tools (clinical and functional tests, noninvasive imaging, histology, and molecular biology), growing data show that successful pancreas transplantation may slow the progression, stabilize, and even favor the regression of secondary complications of diabetes, both microvascular and macrovascular, in a relevant proportion of recipients. Summary: Patients who are referred for pancreas transplantation usually suffer from advanced chronic complications of diabetes, which have classically been deemed irreversible. A successful pancreas transplantation is often able to slow the progression, stabilize, and even reverse many microvascular and macrovascular complications of diabetes. Growing clinical evidence shows that the expected natural history of long-term diabetic complications can be significantly modified by successful pancreas transplantation.Current opinion in organ transplantation 12/2012; 18(1). DOI:10.1097/MOT.0b013e32835c28c5 · 2.88 Impact Factor