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Altered Kidney Graft High-Energy Phosphate Metabolism in Kidney-Transplanted End-Stage Renal Disease Type 1 Diabetic Patients

A cross-sectional analysis of the effect of kidney alone and kidney-pancreas transplantation

¹ Department of Medicine, San Raffaele Scientific Institute, Milan, Italy
² Transplantation Research Center, Children’s Hospital, Harvard Medical School, Boston, Massachusetts
³ Department of Nutrition, San Raffaele Scientific Institute, Milan, Italy
⁴ Faculty of Exercise Sciences, Università degli Studi di Milano, Milan, Italy
⁵ Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
⁶ Università Vita e Salute-San Raffaele, Milan, Italy

Address correspondence and reprint requests to Paolo Fiorina, MD, PhD, Department of Medicine, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy. E-mail: paolo.fiorina{at}hsr.it

OBJECTIVE—Diabetes, hypertension, dyslipidemia, obesity, nephrotoxicity of certain immunosuppressive drugs, and the persistence of a chronic alloimmune response may significantly affect graft survival in end-stage renal disease (ESRD) type 1 diabetic patients who have undergone kidney transplant. The aim of this study was to ascertain the impact of kidney alone (KD) or combined kidney-pancreas (KP) transplantation on renal energy metabolism.

RESEARCH DESIGN AND METHODS—We assessed high-energy phosphates (HEPs) metabolism by using, in a cross-sectional fashion, ³¹P-magnetic resonance spectroscopy in the graft of ESRD type 1 diabetic transplanted patients who received KD (n = 20) or KP (n = 20) transplant long before the appearance of overt chronic allograft nephropathy (CAN). Ten nondiabetic microalbuminuric kidney transplanted patients and 10 nondiabetic kidney transplanted patients with overt CAN were chosen as controls subjects.

RESULTS—Simultaneous KP transplantation patients showed a higher ß-ATP/inorganic phosphorus (Pi) ratio (marker of the graft energy status) versus the other groups, and a positive correlation between ß-ATP/Pi phosphorus ratio and A1C was found. In the analysis limited to the subgroup of normoalbuminuric patients, the difference in ß-ATP/Pi was still detectable in KP patients compared with KD transplantation.

CONCLUSIONS—KP transplantation was associated with better HEPs than in KD transplantation, suggesting that restoration of ß-cell function positively affects kidney graft metabolism.

Abbreviations: ³¹P-MRS, ³¹P-magnetic resonance spectroscope • CAN, chronic allograft nephropathy • ESRD, end-stage renal disease • HEP, high-energy phosphate • KA, microalbuminuric kidney • KD, kidney alone • KP, kidney-pancreas • MRS, magnetic resonance spectroscopy • Pi, inorganic phosphorus • UAE, urinary albumin excretion

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