Original Data

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

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, Piero Marchetti^2,6

Manuscript submitted May 26, 2011; resubmitted July 3, 2011; accepted July 29, 2011.

Keywords: diabetes, pancreas transplantation, retinopathy, diabetic nephropathy, diabetic neuropathy, glomerular filtration rate, proteinuria

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.

Fulltext: HTML , PDF (218KB)

This article has been cited by other articles:

	Pancreas transplantation: a treatment option for people with diabetes Mittal S, Gough SC Diabet Med 2014. 31(5):512-521
	Microangiopathy is common in submucosal vessels of the colon in patients with diabetes mellitus Sasor A, Ohlsson B Rev Diabet Stud 2014. 11(2):175-180
	The therapeutic potential of C-peptide in kidney disease: a protocol for a systematic review and meta-analysis Shaw J, Shetty P, Burns K, Knoll G Syst Rev 2014. 3:43
	Simultaneous kidney and pancreas transplantation in patients with type 1 diabetes mellitus at Clinica Fundacion Valle del Lily, Cali, Colombia Serrano OJ, Villegas JI, Echeverri GJ, Posada JG, Mesa L, Schweineberg J, Duran C, Caicedo LA Rev Colomb Cir 2014. 29:32-41
	Pancreas transplant alone: a procedure coming of age Gruessner RW, Gruessner AC Diabetes Care 2013. 36(8):2440-2447
	Follow-up of secondary diabetic complications after pancreas transplantation Boggi U, Rosati CM, Marchetti P Curr Opin Organ Transplant 2013. 18(1):102-110
	The metabolic and toxicological considerations for immunosuppressive drugs used during pancreas transplantation Rangel EB Expert Opin Drug Metab Toxicol 2012. 8(12):1531-1548
	Evolution of pancreas transplantation: long-term results and perspectives from a high-volume center Ollinger R, Margreiter C, Bösmüller C, Weissenbacher A, Frank F, Schneeberger S, Mark W, Margreiter R, Pratschke J Ann Surg 2012. 256(5):780-786
	Transplantation of the pancreas Boggi U, Vistoli F, Egidi FM, Marchetti P, De Lio N, Perrone V, Caniglia F, Signori S, Barsotti M, Bernini M, Occhipinti M, Focosi D, Amorese G Curr Diab Rep 2012. 12(5):568-579
	In vitro generation of functional insulin-producing cells from human bone marrow-derived stem cells, but long-term culture running risk of malignant transformation Tang DQ, Wang Q, Burkhardt BR, Litherland SA, Atkinson MA, Yang LJ Am J Stem Cells 2012. 1(2):114-127