HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fiorina, P. Articles by Secchi, A. Search for Related Content PubMed PubMed Citation Articles by Fiorina, P. Articles by Secchi, A. Social Bookmarking                What's this?

Long-Term Beneficial Effect of Islet Transplantation on Diabetic Macro-/Microangiopathy in Type 1 Diabetic Kidney-Transplanted Patients

¹ Department of Internal Medicine I, San Raffaele Scientific Institute, Milan, Italy
² Department of Pathology, Insubria University, Varese, Italy
³ Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
⁴ Department of General Surgery, San Raffaele Scientific Institute, Milan, Italy
⁵ Department of Medicine, L’Aquila University, L’Aquila, Italy
⁶ Vita e Salute-San Raffaele University, Milan, Italy

OBJECTIVE—Our aim was to evaluate the long-term effects of transplanted islets on diabetic macro-/microangiopathy in type 1 diabetic kidney-transplanted patients.

RESEARCH DESIGN AND METHODS—A total of 34 type 1 diabetic kidney-transplanted patients underwent islet transplantation and were divided into two groups: successful islet-kidney transplantation (SI-K; 21 patients, fasting C-peptide serum concentration >0.5 ng/ml for >1 year) and unsuccessful islet-kidney transplantation (UI-K; 13 patients, fasting C-peptide serum concentration <0.5 ng/ml). Patients cumulative survival, cardiovascular death rate, and atherosclerosis progression were compared in the two groups. Skin biopsies, endothelial dependent dilation (EDD), nitric oxide (NO) levels, and atherothrombotic risk factors [von Willebrand factor (vWF) and D-dimer fragment (DDF)] were studied cross-sectionally.

RESULTS—The SI-K group showed a significant better patient survival rate (SI-K 100, 100, and 90% vs. UI-K 84, 74, and 51% at 1, 4, and 7 years, respectively, P = 0.04), lower cardiovascular death rate (SI-K 1/21 vs. UI-K 4/13, ² = 3.9, P = 0.04), and lower intima-media thickness progression than the UI-K group (SI-K group: 1–3 years -13 ± 30 µm vs. UI-K group: 1–3 years 245 ± 20 µm, P = 0.03) with decreased signs of endothelial injuring at skin biopsy. Furthermore, the SI-K group showed a higher EDD than the UI-K group (EDD: SI-K 7.8 ± 4.5% vs. UI-K 0.5 ± 2.7%, P = 0.02), higher basal NO (SI-K 42.9 ± 6.5 vs. UI-K 20.2 ± 6.8 µmol/l, P = 0.02), and lower levels of vWF (SI-K 138.6 ± 15.3 vs. UI-K 180.6 ± 7.0%, P = 0.02) and DDF (SI-K 0.61 ± 0.22 vs. UI-K 3.07 ± 0.68 µg/ml, P < 0.01). C-peptide-to-creatinine ratio correlated positively with EDD and NO and negatively with vWF and DDF.

CONCLUSIONS—Successful islet transplantation improves survival, cardiovascular, and endothelial function in type 1 diabetic kidney-transplanted patients.

Abbreviations: DBP, diastolic blood pressure • DDF, D-dimer fragment • ecNOs, endothelial constitutive nitric oxide synthase • EDD, endothelial dependent dilation • IMT, intima-media thickness • SBP, systolic blood pressure • SI-K, successful islet-kidney transplantation • UI-K, unsuccessful islet-kidney transplantation • vWF, von Willebrand factor

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				P. Fiorina, A. Vergani, A. Petrelli, F. D'Addio, L. Monti, R. Abdi, E. Bosi, P. Maffi, and A. Secchi Metabolic and Immunological Features of the Failing Islet-Transplanted Patient Diabetes Care, March 1, 2008; 31(3): 436 - 438. [Abstract] [Full Text] [PDF]

				U. Del Carro, P. Fiorina, S. Amadio, L. De Toni Franceschini, A. Petrelli, S. Menini, F. M. Boneschi, S. Ferrari, G. Pugliese, P. Maffi, et al. Evaluation of Polyneuropathy Markers in Type 1 Diabetic Kidney Transplant Patients and Effects of Islet Transplantation: Neurophysiological and skin biopsy longitudinal analysis Diabetes Care, December 1, 2007; 30(12): 3063 - 3069. [Abstract] [Full Text] [PDF]

				N. Onaca, B. Naziruddin, S. Matsumoto, H. Noguchi, G. B. Klintmalm, and M. F. Levy Pancreatic Islet Cell Transplantation: Update and New Developments Nutr Clin Pract, October 1, 2007; 22(5): 485 - 493. [Abstract] [Full Text] [PDF]

				P. Raggi and A. Bellasi Review: Imaging to assess effect of medical therapy in patients with diabetes mellitus The British Journal of Diabetes & Vascular Disease, July 1, 2007; 7(4): 157 - 164. [Abstract] [PDF]

				P. Raggi, A. Bellasi, and C. Ratti Ischemia Imaging and Plaque Imaging in Diabetes: Complementary tools to improve cardiovascular risk management Diabetes Care, November 1, 2005; 28(11): 2787 - 2794. [Abstract] [Full Text] [PDF]

				P. Fiorina, M. Venturini, F. Folli, C. Losio, P. Maffi, C. Placidi, S. La Rosa, E. Orsenigo, C. Socci, C. Capella, et al. Natural History of Kidney Graft Survival, Hypertrophy, and Vascular Function in End-Stage Renal Disease Type 1 Diabetic Kidney-Transplanted Patients: Beneficial impact of pancreas and successful islet cotransplantation Diabetes Care, June 1, 2005; 28(6): 1303 - 1310. [Abstract] [Full Text] [PDF]

				P. Fiorina, C. Gremizzi, P. Maffi, R. Caldara, D. Tavano, L. Monti, C. Socci, F. Folli, F. Fazio, E. Astorri, et al. Islet Transplantation Is Associated With an Improvement of Cardiovascular Function in Type 1 Diabetic Kidney Transplant Patients Diabetes Care, June 1, 2005; 28(6): 1358 - 1365. [Abstract] [Full Text] [PDF]

				E. A. Ryan, B. W. Paty, P. A. Senior, J. R.T. Lakey, D. Bigam, and A.M. J. Shapiro {beta}-Score: An assessment of {beta}-cell function after islet transplantation Diabetes Care, February 1, 2005; 28(2): 343 - 347. [Abstract] [Full Text] [PDF]

				M. Venturini, E. Angeli, P. Maffi, P. Fiorina, F. Bertuzzi, M. Salvioni, F. De Cobelli, C. Socci, L. Aldrighetti, C. Losio, et al. Technique, Complications, and Therapeutic Efficacy of Percutaneous Transplantation of Human Pancreatic Islet Cells in Type 1 Diabetes: The Role of US Radiology, February 1, 2005; 234(2): 617 - 624. [Abstract] [Full Text] [PDF]

				P. Fiorina, F. Folli, A. D'Angelo, G. Finzi, F. Pellegatta, V. Guzzi, C. Fedeli, P. D. Valle, L. Usellini, C. Placidi, et al. Normalization of Multiple Hemostatic Abnormalities in Uremic Type 1 Diabetic Patients After Kidney-Pancreas Transplantation Diabetes, September 1, 2004; 53(9): 2291 - 2300. [Abstract] [Full Text] [PDF]

				F. Zaman, K. D. Abreo, S. Levine, W. Maley, and G. B. Zibari Pancreatic Transplantation: Evaluation and Management J Intensive Care Med, May 1, 2004; 19(3): 127 - 139. [Abstract] [PDF]

				R. P. Robertson Islet Transplantation as a Treatment for Diabetes -- A Work in Progress N. Engl. J. Med., February 12, 2004; 350(7): 694 - 705. [Full Text] [PDF]

				P. Fiorina, F. Folli, G. Zerbini, P. Maffi, C. Gremizzi, V. Di Carlo, C. Socci, F. Bertuzzi, M. Kashgarian, and A. Secchi Islet Transplantation Is Associated with Improvement of Renal Function among Uremic Patients with Type I Diabetes Mellitus and Kidney Transplants J. Am. Soc. Nephrol., August 1, 2003; 14(8): 2150 - 2158. [Abstract] [Full Text] [PDF]