Impact of Simultaneous Pancreas and Kidney Transplantation on Progression of Coronary Atherosclerosis in Patients With End-Stage Renal Failure due to Type 1 Diabetes
- J. Wouter Jukema, MD, PHD1,
- Yves F. C. Smets, MD2,
- Johan W. van der Pijl, MD, PHD3,
- Aeilko H. Zwinderman, MD, PHD4,
- Hubert W. Vliegen, MD, PHD1,
- Jan Ringers, MD5,
- Johan H. C. Reiber, PHD1,
- Herman H. P. J. Lemkes, MD, PHD2,
- Ernst E. van der Wall, MD, PHD1 and
- Johan W. de Fijter, MD, PHD3
- 1Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- 2Department of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
- 3Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands
- 4Department of Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands
- 5Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
Abstract
OBJECTIVE—Mortality in type 1 diabetic patients with end-stage renal failure is high and dominated by coronary atherosclerotic events. With regard to prognosis, simultaneous transplantation of pancreas and kidney (SPK) may be superior to kidney transplantation alone (KTA) in type 1 diabetic patients, because normalization of blood glucose levels may reduce progression of coronary atherosclerosis and because it is well known that progression of coronary atherosclerosis is one of the major factors that determines clinical prognosis. However, no data are available on progression of coronary atherosclerosis after SPK.
RESEARCH DESIGN AND METHODS—We performed an observational angiographic study comparing progression of coronary atherosclerosis, analyzed with quantitative coronary angiography, in patients with (n = 26) and those without (n = 6) a functioning pancreas graft after SPK, to test the hypothesis that normalization of blood glucose levels by SPK may indeed reduce progression of coronary atherosclerosis in type 1 diabetic patients and thereby improve prognosis.
RESULTS—Mean follow-up was 3.9 years. Average glucose control was significantly worse for the patients without a pancreas graft than for patients with a functioning pancreas graft: 11.3 (SD 3.5) vs. 5.9 mmol/l (SD 1.1) (P = 0.03). Mean segment diameter loss (progression of diffuse coronary atherosclerosis) was 0.024 mm/year (SD 0.067) in patients with a functioning pancreas graft, compared with 0.044 mm/year (SD 0.038) in patients in whom the pancreas graft was lost. Minimum obstruction diameter loss (progression of focal coronary atherosclerosis) was 0.037 mm/year (SD 0.086) in patients with a functioning pancreas graft compared with 0.061 mm/year (SD 0.038) in patients in whom the pancreas graft was lost. Regression of atherosclerosis occurred in 38% of patients with a functioning pancreas graft compared with 0% of patients of whom the pancreas graft was lost (P = 0.035).
CONCLUSIONS—Our study provides, for the first time, evidence that in patients who have undergone SPK, progression of coronary atherosclerosis in patients with a functioning pancreas graft is reduced compared with patients with pancreas graft failure. Our observation is an important part of the explanation for the observed improved mortality rates reported in type 1 diabetic patients with end-stage renal failure after SPK compared with KTA. In light of these findings described above, SPK must to be carefully considered for all diabetic transplant candidates.
- CAG, coronary arteriography
- KTA, kidney transplantation alone
- MOD, minimum obstruction diameter
- MSD, mean segment diameter
- PTCA, percutaneous transluminal coronary angioplasty
- QCA, quantitative coronary arteriography
- SPK, simultaneous transplantation of pancreas and kidney
Footnotes
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Address correspondence and reprint requests to J. Wouter Jukema, MD, PhD, FESC, FACC, Head, Interventional Cardiology, Leiden University Medical Center, Department of Cardiology, C5-P, P.O. Box 9600, 2300 RC Leiden, the Netherlands. E-mail: j.w.jukema{at}lumc.nl.
Received for publication 30 August 2001 and accepted in revised form 11 February 2002.
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